Archives 2015 Hepatitis C Full Text Articles
Full text articles from peer reviewed journals covering every aspect of hepatitis C and hepatitis B management.
2016-Hepatitis C Research Articles
2016-Hepatitis C Research Articles
Dec 24 2015
- Ledipasvir/sofosbuvir Treatment in Hepatitis C Virus Journal of Viral Hepatitis, December 24, 2015
- Improved Fibrosis Staging in Patients With Liver Disease Liver International, December 23, 2015
The prevalence of mixed genotype infections in Polish patients with hepatitis C.
The obtained results showed that infection with mixed HCV genotypes in Polish patients with hepatitis C, is uncommon. Selective elimination of genotypes 3a and 4a after therapy confirms the genotype 1b greater resistance to treatment. In the context of new anti-HCV drug development further investigations are needed to determine the clinical importance of mixed hepatitis C infection. Abbreviated title: Mixed genotype infections with hepatitis C in Polish patients. Mixed genotype hepatitis C infections.
Hepatitis C genotype 4: The past, present, and future.
Direct-acting antivirals may significantly improve treatment outcomes in HCV- GT-4, but use of these agents in countries endemic for HCV-GT-4 is currently precluded by the very high costs. A new hepatitis C vaccine from GlaxoSmithKline has shown promise in early clinical tests, prompting strong and broad immune responses. Another Egyptian clinical trial in the field of HCV vaccination: Clinical Trials phases I and II, started on March 2011. ClinicalTrials.gov Identifier NCT01718834.
Improved Fibrosis Staging in Patients With Liver Disease
Liver International, December 23, 2015
Hepatitis C in the Era of Direct-Acting Antivirals
BMC Infectious Diseases, December 22, 2015
A Once-daily NS5A Inhibitor in Patients With Genotype 1-4 HCV
Journal of Viral Hepatitis, December 18, 2015
New Drug Review 2015
U.S. Pharmacist, December 18, 2015
The Hepatitis C Revolution Part 1
This review article discusses novel hepatitis C virus treatment options in hopes to clarify best available evidence for clinicians treating patients with HCV.
December 09, 2015
HCV genotype 3: a wolf in sheep’s clothing
Moving on to the third point, and so concluding this topic, it is necessary to understand the clinical implications of the different HCV G3 subtypes (in other words, immunity, inflammation, prognosis, response to DAAs). This is something we already known for HCV G1a and 1b. At least 10 HCV G3 subtypes have been described so far. Are some of these HCV G3 subtypes able to evade the immune response? Can we expect the same SVR for different subtypes? The correct identification of HCV G3 subtypes would probably be necessary because they are crucial in clinical trials evaluating the new DAAs. No data have so far stratified the response of HCV G3 to the new DAAs, which could be an essential issue that requires further investigation.
Clinical Outcome in Post-transplant Hepatitis C Recurrence
Liver International, December 2, 2015
Hepatitis C Virus Treatment in the Real World
Gut, December 1, 2015
Treatment of type 2 diabetes mellitus by viral eradication in chronic hepatitis C: Myth or reality?
New England Journal Of Medicine
Sofosbuvir and Velpatasvir for HCV Genotype 2 and 3 Infection
Here, we present the results of two randomized, controlled, phase 3 trials (ASTRAL-2 and ASTRAL-3) in which treatment with a fixed-dose combination tablet of sofosbuvir and velpatasvir for 12 weeks was compared with standard treatment with sofosbuvir plus ribavirin for 12 or 24 weeks in patients who had received prior treatment for HCV genotype 2 or 3 infection and in those who had not received such treatment, including those with compensated cirrhosis
Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis
The NS5B nucleotide inhibitor sofosbuvir is approved for the treatment of HCV infection in combination with other agents.13,14 Velpatasvir (formerly known as GS-5816, Gilead Sciences) is an investigational inhibitor of the HCV NS5A protein with antiviral activity against all HCV genotypes.15-17 The combination of velpatasvir and sofosbuvir with or without ribavirin provided high rates of sustained virologic response in patients with all HCV genotypes in phase 2 clinical trials.18,19 In the phase 3 ASTRAL-1, ASTRAL-2, and ASTRAL-3 trials (now published in theJournal),20,21 treatment with sofosbuvir–velpatasvir in a fixed-dose combination tablet for 12 weeks resulted in high rates of sustained virologic response among patients with HCV genotypes 1 through 6 without cirrhosis or with compensated cirrhosis.
Sofosbuvir and Velpatasvir for HCV Genotype 1, 2, 4, 5, and 6 Infection
We conducted a phase 3 trial (ASTRAL-1) to assess the efficacy and safety of 12 weeks of treatment with a fixed-dose combination of velpatasvir and sofosbuvir among both previously treated and untreated patients who were chronically infected with HCV genotype 1, 2, 4, 5, or 6, including those with compensated cirrhosis.
A New Era of Therapy for Hepatitis C Virus Infection
Current Opinion in Infectious Diseases, November 9, 2015
Hepatitis C virus-associated neurocognitive and neuropsychiatric disorders: Advances in 2015
Neurocognitive dysfunction, sleep disturbance, depression, fatigue and reduced quality of life are common manifestations of chronic hepatitis C virus (HCV) infection. Neuropsychological performance is impaired in HCV patients, in the absence of structural brain alterations on conventional magnetic resonance imaging (MRI). Brain metabolic and microstructural changes are easily detected by in vivo proton magnetic resonance spectroscopy and perfusion-weighted/diffusion tensor MRI, enabling detection of brain dysfunction in clinically asymptomatic subjects. The regional distribution of metabolic changes indicates an exclusive involvement of telencephalic areas, but not the diencephalon or brainstem. HCV is likely to play a major pathogenic role in these disorders.
Alcoholic Hepatitis and HCV Interactions in the Modulation of Liver Disease
Alcoholic liver disease and chronic HCV infection together are the most common causes of liver disease, and can promote rapid disease progression. How should patients with these concurrent diseases be treated?
November 06, 2015
Extrahepatic Morbidity and Mortality of Chronic Hepatitis C Review - SVR Clears/Reduces Extrahepatic Manifestations
This review discusses the many extra hepatic manifestations of HCV including heart disease, NHL/cancer, neurologic & the brain, touches on kidney disease, mixed cryoglobulinemia (MC)....and describes how SVR reduces or clears these disease and improves overall survival
November 05, 2015
Hepatitis C virus infection: Are there still specific problems with genotype 3?
This article reviews the complex relationship between hepatitis C virus (HCV) genotypes and the possible complications in chronically infected patients. We discuss recent updates on the epidemiology and clinical aspects of HCV genotype 3 infection, including the currently available therapies. We also describe model systems to study the HCV genotype-specific molecular mechanisms.
Therapy With Direct-Acting Antivirals for Genotype 3 Patients: Interferon's Last Gasp? Commentary
Hepatitis C virus (HCV) genotypes (GTs) 2 and 3 account for approximately 40% of infections by this virus worldwide.1 Patients with HCV GT3 have more rapid disease progression and are less responsive to treatment than those with GT2,2 and GT3 infection is considered relatively difficult to cure with the available direct-acting antivirals
November 05, 2015
Diabetes Thought to Increase Risk for Hepatic Cancer
A retroactive study presented at the 2015 Annual Meeting for the American College of Gastroenterology (ACG) suggests that diabetes increases the risk for hepatocellular carcinoma. Hepatocellular carcinoma is the most common form of liver cancer. The disease generally occurs secondary to hepatitis C infection or in cirrhosis from other causes.
Early changes in dynamic biomarkers of liver fibrosis in hepatitis C virus-infected patients treated with sofosbuvir
This is the first study investigating the effects of a sofosbuvir-based, highly efficient antiviral therapy for CHC on early changes in parameters of liver fibrosis progression. The non-invasive serological and ultrasound-based markers ELF and LSM suggest a significant regression of liver fibrosis at SVR12 compared to baseline
Transient Elastography in Assessing Liver Fibrosis
Liver International, October 28, 2015
Risk of HCC in Chronic HCV Patients With New Onset Diabetes
Alimentary Pharmacology & Therapeutics, October 26, 2015
Slower Fibrosis Progression Among Liver Transplant Recipients With Sustained Virological Response After Hepatitis C Treatment
All-oral interferon-free treatments: The end of hepatitis C virus story, the dream and the reality
The fantastic race for effective treatment for HCV has reached the final straight and the finishing line that marks the fulfillment of the dream can be clearly seen. Although the reality has exceeded all expectations, the Healthcare Authorities do not appear to be ready to take on the challenge for victory.
HCV Infection: A Risk Factor for Parkinson's Disease
Journal of Viral Hepatitis, October 16, 2015
Treatment Response in Sofosbuvir-Based Therapy of HCV
BMC Gastroenterology, October 13, 2015
Efficacy and Safety of Ombitasvir, Paritaprevir, and Ritonavir in an Open-Label Study of Patients With Genotype 1b Chronic Hepatitis C Virus Infection With and Without Cirrhosis
An interferon- and ribavirin-free regimen of ombitasvir, paritaprevir, and ritonavir, achieved high rates of SVR12 in patients with HCV GT1b infection with and without cirrhosis. This regimen was well tolerated and was associated with low rates of treatment discontinuation
Global Patterns of Hepatocellular Carcinoma Management From Diagnosis to Death
How is hepatocellular cancer treated around the world, and how do treatment patterns affect outcomes?
HCV targeting of patients with cirrhosis
Journal Of Hepatology
Previously difficult to treat patients by IFN-containing treatments can now be treated safely by IFN-free therapies. More than 90% of hepatitis C genotype 1 and 4 patients with compensated cirrhosis or after orthotopic liver transplantation (OLT) can be cured by sofosbuvir combined with simeprevir, daclatasvir or ledipasvir, or by the paritaprevir/ritona-vir/ombitasvir/±dasabuvir (3D) combination
Cell Death Discovery - Nature
The major risk factors for the development of HCC are hepatitis B/Cviruses (HBV/HCV), nonalcoholic steatohepatitis and alcohol, presumably because of their ...
Treatment of Chronic HCV in Patients With Cirrhosis
The American Journal of Gastroenterology
The availability of INF-free oral antiviral therapies allows for the first time many patients with cirrhosis, including those with hepatic decompensation and other contraindications to PEGINF, to receive highly effective HCV treatment.
Diabetes and hepatitis C: a two-way association
Type 2 diabetes (T2D) and hepatitis C are prevalent diseases worldwide. The World Health Organization (WHO) reported that 170 million people are chronically infected with hepatitis C virus (HCV) globally (1), and 347 million have diabetes mellitus (DM). Despite decreasing prevalence of hepatitis C infection in the United States, the disease burden continues to grow due to hepatitis C-related diseases (2). Studies have shown that more than one-third of patients with chronic HCV infection will develop at least one extrahepatic manifestation
An Algorithm to Predict HCC in Those With HCV and Cirrhosis
Prevalence of Cirrhosis in Hepatitis C Patients
The American Journal of Gastroenterology
Assessing cardiovascular risk in hepatitis C: An unmet need.
Chronic hepatitis C is associated with significant morbidity and mortality, as a result of the progression towards cirrhosis and hepatocellular carcinoma. Furthermore, hepatitis C virus seems to be an independent risk factor for cardiovascular diseases due to its association with insulin resistance, diabetes and steatosis. The advent of new direct acting antiviral therapy has dramatically increased the sustained virological response rates of hepatitis C infection. In this scenario, the cardiovascular risk has emerged and represents a major concern after achieving the eradication of the virus.
Psychosocial assessment and monitoring in the new era of non-interferon-alpha hepatitis C virus treatments
The recently Food and Drug Administration approved direct-acting antiviral regimens for hepatitis C virus (HCV), ledipasvir/sofosbuvir regimen and the ombitasvir/paritaprevir/ritonavir and dasabuvir regimen, have demonstrated great efficacy, and thus far seem to have short treatment timelines and relatively benign side effect profiles. Depression has not emerged as a side effect of these treatments. With efficacious regimens that include no interferon-alpha and no ribavirin, there may no longer be a need for strong psychosocial assessment and monitoring built into the routine of HCV treatment. Good history-taking, strong pharmaceutical review, and reliable consultative relationships should be adequate for meeting psychosocial needs in HCV treatment
Hepatitis C Genotype 3 - Updated Label for Daklinza (daclatasvir) Approved by the European Commission
Daklinza in combination with sofosbuvir is the first 12-week all-oral therapy for genotype 3 patients without cirrhosis in Europe
Interferon-free therapies improve liver function in HCV patients
Antiviral therapy without interferon improved liver function in patients with hepatitis C virus infection-related advanced cirrhosis, according to data from an observational cohort study.
Researchers analyzed data of 80 patients with HCV-associated liver cirrhosis undergoing treatment with a combination of direct-acting antivirals without interferon. Of these patients, 43% had Child-Pugh B/C cirrhosis (n = 34), and 53% had platelet counts of less than 90,000/μL (n = 42). The combination regimens included Sovaldi (sofosbuvir, Gilead Sciences) with ribavirin (n = 56), Olysio (sofosbuvir/simeprevir, Janssen Therapeutics) with or without ribavirin (n = 15) and sofosbuvir and Daklinza (daclatasvir, Bristol-Myers Squibb) with or without ribavirin (n = 9). Most patients had HCV genotype 1 (n = 50), followed by 24 with genotype 3, four with HCV genotype 2 and two patients with genotype 4.
Improvement of liver function parameters in advanced HCV-associated liver cirrhosis by IFN-free antiviral therapies
Effectiveness of Sofosbuvir-based Regimens in Genotype 1 and 2 Hepatitis C Virus Infection in 4026 U.S. Veterans
Do sofosbuvir-based regimens bring about sustained virological response in patients with genotype 1 and 2 hepatitis C infection?
Therapy for Hepatitis C Genotype 3: Moving Forward
This article reviews the available therapy and the new treatment agents under development for patients with chronic hepatitis C GT3 infection.
Hepatitis C - Fibrosis index based on four factors better predicts advanced fibrosis or cirrhosis than aspartate aminotransferase/platelet ratio index
Hepatic fibrosis is one of the important factors associated with the long-term prognosis of CHC patients. If noninvasive methods could accurately predict the severity of hepatic fibrosis, the majority of liver biopsies could be avoided.
Ledipasvir-sofosbuvir plus ribavirin in advanced HCV does well
Click here for Full Text Aricle
Key clinical point: Ledipasvir-sofosbuvir plus ribavirin for 12 weeks achieved high SVR rates among patients with hepatitis C virus infection and advanced liver disease.
Meta-analysis- SVR and its Treatment Predictors in HCV Genotype 4 Compared to Genotypes 1, 2, and 3
Does treatment with pegylated interferon and ribavirin bring about sustained virological response in HCV genotype 4 as compared to genotypes 1, 2, and 3?
One in Four Hepatitis C Patients Denied Initial Approval for Drug Treatment
Drug Authorization for Sofosbuvir/Ledipasvir (Harvoni) for Chronic HCV Infection in a Real-World Cohort: A New Barrier in the HCV Care Cascade
Early analysis of real-world drug authorization outcomes between October-December 2014 reveals that nearly one in four patients are initially denied access to SOF/LED upon initial prescription, although most patients are eventually approved through appeal, which delays treatment initiation. Having Medicare/Medicaid and advanced liver disease resulted in a higher likelihood of approval as well as earlier decision and approval times. More studies are needed to determine factors resulting in higher likelihood of denial and to evaluate approval rates and times after implementation of restrictive prior authorization guidelines.
Liver Toxicity Associated with Sofosbuvir, an NS5A Inhibitor and Ribavirin Use
Jessica K Dyson, John Hutchinson, Laura Harrison, Olorunda Rotimi, Dina Tiniakos, Graham R Foster, Mark A Aldersley, Stuart McPherson
Published Online: August 29, 2015
Publication stage: In Press Accepted Manuscript
Hepatitis C (HCV) is a major cause of end-stage liver disease and hepatocellular carcinoma. There have been rapid advances in HCV treatment with the development of oral direct acting antivirals (DAAs). Studies have shown sustained virological response rates above 90% with combinations of DAAs, including patients with compensated cirrhosis. Thus far, significant drug toxicity has not been seen with these agents, but there is limited experience of using DAAs in decompensated HCV cirrhosis. This report describes the first experience of serious drug-induced hepatotoxicity with the new DAAs. The mechanism underlying these drug reactions is currently unknown. Few patients with decompensated cirrhosis have been treated with DAAs, so the exact pharmacokinetics in this population have not been characterised. In both cases patients were taking or had recently taken other drugs. It is possible that an unknown interaction or reaction to the drug combination caused the hepatotoxicity. Although the association with the DAAs is not proven these cases indicate that patients with advanced liver disease need close monitoring while on DAA therapy and if there is a significant unexplained deterioration in liver function the DAAs should be discontinued.
Hepatitis C treatment: Back to the warehouse
Like many physicians that specialize in hepatitis C virus (HCV) treatment, I have spent the last few years advising many of my patients with chronic HCV infection to defer treatment and wait for new therapies. For those without advanced fibrosis or an extraintestinal manifestation of HCV, this process of “warehousing” patients for future HCV treatment made perfect sense. Why undergo interferon-based therapy, with all of the side effects and marginal results, when it was becoming clear that highly efficacious, interferon-free therapy was close to becoming a reality? Patients, advocacy groups, and physicians closely followed the development of sofosbuvir (Sovaldi), simeprevir (Olysio), sofosbuvir/ledipasvir (Harvoni), and paritaprevir/ritonavir/ombitasvir/dasabuvir (Viekira Pak) among others in eager anticipation of US Food and Drug Administration (FDA) approval and, for most patients, the possibility of a cure of their HCV infection.
Interferon-free regimens for the treatment of hepatitis C virus in liver transplant candidates or recipients
Treatment against hepatitis C virus has dramatically improved with the novel direct-acting antivirals (DAAs). The currently available DAAs are sofosbuvir, simeprevir, daclatasvir, ledipasvir/sofosbuvir, paritaprevir/ombitasvir and dasabuvir. IFN-free combinations of these novel DAAs with or without ribavirin give excellent sustained virological response in patients with decompensated cirrhosis awaiting liver transplantation and those with recurrence of hepatitis C post liver transplantation. More data regarding the safety and efficacy of these new DAAs are needed, but ongoing clinical trials and real life data will clarify better these issues.
Prevalence of Insomnia and Sleep Patterns among Liver Cirrhosis Patients
Few studies are available regarding the prevalence of sleep disturbance in cirrhotic patients without overt hepatic encephalopathy. This study aimed to assess the prevalence of insomnia in stable liver cirrhosis patients who are attending the outpatient clinics at King Abdulaziz Medical City, Riyadh (KAMC-KFNGH).
A survey on herbal management of hepatocellular carcinoma
In this review we outline the different mechanisms mediating hepatocarcinogenesis. We also discuss possible targets of bioactive herbal agents at different stages of hepatocarcinogenesis and highlight their role at each individual stage. We gathered information on the most common herbal prescriptions and extracts thought to be useful in prevention or sensitization for chemotherapy in management of hepatocellular carcinoma (HCC). The value of this topic may seem questionable compared to the promise offered for HCC management by chemotherapy and radiation. However, we would recommend the use of herbal preparations not as alternatives to common chemo /and or radiotherapy, but rather for prevention among at-risk individuals, given that drug/herb interactions are still in need of extensive clarification. The bioactive constituents of various herbs seem to be promising targets for isolation, cancer activity screening and clinical evaluation. Finally, herbal preparations may offer a cost effective protective alternative to individuals known to have a high risk for HCC and possibly other cancers, through maintaining cell integrity, reversing oxidative stress and modulating different molecular pathways in preventing carcinogenesis.
Does herbal medicine reduce the risk of hepatocellular carcinoma?
This review focuses on evidence based trials of herbal traditional Chinese medicine (TCM) in managing gastrointestinal disorders and presents a practical reference guide on its role for treating these diseases. Overall quality of placebo controlled, randomized, controlled, double-blind clinical trials was poor; mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in most gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. Despite its interesting philosophical background with a long history, the general use of herbal TCM to treat various gastrointestinal diseases cannot be recommended due to lacking evidence based efficiency and a negative risk/benefit profile. Thus, substantial skepticism remains, proposing future studies with focus on well performed placebo controlled, randomized, double-blind clinical trials. Herbal product quality and standard criteria for diagnosis, treatment, and outcome should also be considered.
Does antiviral therapy reduce complications of cirrhosis?
The goals of antiviral therapy in hepatitis B virus-related cirrhosis would be to improve the hepatic disease severity, improve the clinical symptoms and quality of life, and prolong patient’s survival. Despite the limitations, antiviral therapy with nucleos(t)ide in patients with HBV-related cirrhosis can prevent the development of complications from cirrhosis, particularly, decompensation and acute-on-chronic liver failure (ACLF). Early antiviral treatment is important for patients with severe decompensated cirrhosis and ACLF. Thus, physicians could treat these patients using lamivudine with careful monitoring for the development of resistance or using the most potent antiviral agent, such as entecavir or tenofovir.
Landmark Developments in Pediatrics: 1995-2015
Russell W. Steele, MD; Patrick J. Unkel, MD
Now, with the routine use of the hepatitis B vaccine, hepatitis C is the number one cause of chronic hepatitis. In the United States, the CDC estimates that there are 2.7 million chronic carriers. Hepatitis C may soon be the most common type of chronic hepatitis in children. In one study, it was estimated that 4.5% of childbearing women in the United States are affected. Mothers with chronic hepatitis C have a 4%-7% chance of infecting the baby at delivery.
New treatment strategies for hepatitis C infection
Core tip: In this review, we focused on different treatment regimens for hepatitis C infection, especially those including the newly developed and approved direct-acting antivirals. The guidelines are constantly changing in light of new studies. The recommendations of the guidelines are reviewed and consider different genotypes of the virus in addition to the results of ongoing studies. Continuing medical need for agents that act on novel hepatitis C virus targets has resulted in new compounds targeting viral proteins, which is also highlighted in the manuscript.
HCV: The Best Cure Possible or the Best Possible Cure?
Journal of Viral Hepatitis, August 21, 2015
The Patient's Journey With Chronic Hepatitis C
Alimentary Pharmacology & Therapeutics, August 10, 2015
Clinical Impact of Treatment Timing for Chronic HCV
Journal of Viral Hepatitis, August 7, 2015
AASLD/IDSA Guidlines Updated: When and In Whom to Initiate Therapy
The When and In Whom to Initiate Therapy, Initial Treatment, Retreatment, Acute HCV Infection, and Unique Populations (HIV/HCV Coinfection, Decompensated Cirrhosis, and Renal Impairment) sections have been updated to reflect newly available data presented at the European Association for the Study of the Liver (EASL) International Liver Congress 2015.
HCV Guidance is available as an "Accepted Article" in HEPATOLOGY
Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus
Early virological response may predict treatment response in sofosbuvir-based combination therapy of chronic hepatitis c in a multi-center “real-life” cohort
Advances in Hepatitis C Treatment: At the Crossroads
Journal for Nurse Practitioners, August 5, 2015
Cost-effectiveness of Sofosbuvir-based Regimens for HCV
Gut, August 4, 2015
Increased risk of hepatocellular carcinoma in chronic HCV patients with new onset diabetes
31 July 2015
A study published ahead of print the Alimentary Pharmacology & Therapeutics reports an increased risk of hepatocellular carcinoma in chronic HCV patients with new onset diabetes.
Efficacy and Safety of Daclatasvir for Chronic HCV
Alimentary Pharmacology & Therapeutics, August 3, 2015
Safety of the First Interferon-Free Therapy Against Hep C
Liver International, July 29, 2015
Injection Drug Use and HCV and Risk for Mortality in HIV
JAIDS: Journal of Acquired Immune Deficiency Syndromes, July 28, 2015
Comparing Therapeutic Regimens for Pediatric Chronic HCV
Alimentary Pharmacology & Therapeutics, July 20, 2015
Enhanced Surveillance of Hepatitis C
Journal of Viral Hepatitis, July 17, 2015
Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States
Causes of death in people with chronic HBV infection
A study in this month's issue of the Journal of Hepatology investigates the excess risk of death in HBV patients compared with mortality in the general population.
Successes and Challenges on the Road to Cure Hepatitis C
The past year has seen the approval of five interferon-free direct-acting antiviral (DAA) regimens for HCV, including combinations of DAAs and fixed-dose combination pills ..
Noninvasive Assessment of Liver Fibrosis
Current Opinion in Gastroenterology, June 17, 2015
Hepatitis C: 25 Years Old, and Fading
Medscape - During 2014, the 25th anniversary of the identification of the hepatitis C virus (HCV), it became clear that a spate of new antiviral drugs and novel treatment strategies heralded a future in which a significant proportion of patients can be cured of ...
Changes in Characteristics of HCV Patients in the Last Decade
Journal of Viral Hepatitis, June 5, 2015
In this study of 1348 patients with chronic hepatitis C newly referred to our liver centre, we found as expected patients seen in Era-2 (2011–2012) were older and more likely to have advanced liver disease compared to those seen a decade ago (Era-1, 1998–1999).
Hepatocellular carcinoma: From diagnosis to treatment
Hepatocellular carcinoma (HCC) is a rising cause of cancer related mortality and viral causes of cirrhosis appear to be a major cause. Surveillance helps to detect early stage disease and treatment options are determined by stage of presentation. Three potentially curative options are radiofrequency ablation, liver transplantation and tumor resection. Emerging therapies such as drug-eluting beads-transarterial chemoembolization or sorafenib will continue to advance treatment options in HCC. The following will provide a concise review of HCC from prevention to treatment.
Gastroenterology & Hepatology Volume 11, Issue 5 May 2015
Antiviral Therapy in Elderly Patients With Hepatitis C Virus ...
The emergence of direct-acting antiviral (DAA) agents has revolutionized the treatment schema for hepatitis C virus (HCV) infection. From cure rates to tolerability, DAA agents have shown outstanding profiles compared with the prior therapy of pegylated interferon with ribavirin. However, the efficacy and safety profiles of DAA therapy in older patients, particularly the elderly, have been unclear, and patients in the 1945 to 1965 birth cohort constitute the largest proportion of the HCV population in the United States. Treating elderly patients with pegylated interferon and ribavirin has been challenging due to the frequent presence of multiple comorbidities in the elderly and high discontinuation rates caused by adverse events. Now, as more DAA agents have become widely studied and approved, subgroup analyses for the elderly population are being elucidated. Analysis of the current literature shows that these agents have been effective, well tolerated, and safe in the elderly population. This article highlights the efficacy and safety differences in interferon-based therapy and interferon-free regimens for elderly patients with HCV
Studies on the epidemiology of hepatitis B and C virus infections are still needed
Full Text - PDF
Long-term treatment outcomes of patients infected with Hepatitis C virus: a systematic review and meta-analysis of the survival benefit of achieving a Sustained Virological Response
ASSOCIATION OF CAFFEINE INTAKE AND LIVER FIBROSIS IN PATIENTS WITH CHRONIC HEPATITIS C
In conclusion, the higher caffeine intake was associated with a lower degree of liver fibrosis in HCV-infected patients. There was no association between caffeine consumption and inflammatory activity.
25 years of Hepatitis C
(Source: Arquivos de Gastroenterologia)
Source: Arquivos de Gastroenterologia - May 23, 2015
Changing the face of hepatitis C management – the design and development of sofosbuvirTransient Elastography for Chronic Viral Hepatitis
Cognitive dysfunction (brain fog) and hepatitis C
Cognitive dysfunction in patients with chronic hepatitis C virus (HCV) infection is a distinct form of minimal hepatic encephalopathy. It is unclear to what extent HCV triggers an irreversible neurodegenerative brain damage...
To Study the Prevalence of Impaired Glucose Tolerance in Patients with Hepatitis C Virus Related Chronic Liver Disease
The objective of our study was to study the prevalence of impaired glucose tolerance in patients with HCV related liver disease.
Management of Treatment-naive Chronic HCV Genotype 1 Patients
Journal of Viral Hepatitis
Daclatasvir, Asunaprevir, and Beclabuvir
Full Text Available @ NATAP
Editorial: Continued Progress Against Hepatitis C Infection
Daclatasvir in Combination With Asunaprevir and Beclabuvir for Hepatitis C Virus Genotype 1 Infection With Compensated Cirrhosis
Fixed-Dose Combination Therapy With Daclatasvir, Asunaprevir, and Beclabuvir for Noncirrhotic Patients With HCV Genotype 1 Infection
Author Interview @ JAMA - ARTICLE: Daclatasvir in Combination With Asunaprevir and Beclabuvir for Hepatitis C Virus Genotype 1 Infection With Compensated Cirrhosis
Interferon-free therapy for hepatitis C: The hurdles amid a golden era
The long awaited all-oral therapy for hepatitis C virus infection has officially been inaugurated by the registration of the hepatitis C nucleotide inhibitor sofosbuvir in a combination regimen with ribavirin. More recently, the oral array to treat hepatitis C has been enriched by the arrival of the NS5A inhibitors ledipasvir (also in a single formulation with sofosbuvir, Harvoni®) and daclatasvir; the protease inhibitor simeprevir, and the Viekirax® + ExvieraTM regimen based on the ritonavir boosted protease inhibitor paritaprevir; the NS5A inhibitor ombitasvir, and the non-nucleoside inhibitor dasabuvir
Resource Utilization for Patients Hospitalized for HCV
Journal of Viral Hepatitis, May 1, 2015
Sorting out cirrhosis: Mechanisms of non-response to hepatitis C therapy
Although cirrhosis has long been recognized as an important negative predictor of treatment response for hepatitis C virus (HCV) therapy, the mechanisms underlying this association remain relatively poorly understood.
Hepatitis C virus: Is it time to say goodbye yet?
Perspectives and challenges for the next decade
Systematic review with meta-analysis: comparison between therapeutic regimens for paediatric chronic hepatitis C
The search sourced 23 peer-reviewed articles which enrolled 934 cases, aged 2–19 years. Sustained virological response rates were significantly higher with the addition of ribavirin to either interferonα or pegylated nterferonα vs. their monotherapies for genotypes 1,2&3 with crude and weighted estimates. The weighted estimate indicated higher sustained virological response rates for those treated with pegylated interferonα+ribavirin vs. interferonα+ribavirin for genotype 1 (50% vs. 40%) and genotypes 2&3 (90% vs. 84%), (odds ratio 1.5, 95% confidence interval 1.2–1.8, and 1.8, 1.2–2.9 respectively). Cases with genotype 4 treated with pegylated interferonα+ribavirin had a lower sustained virological response (41%) vs. genotype 1 (1.4, 1.2–1.8), and vs. genotypes 2&3 (13.5, 10.3–17.9). Some adverse events were significantly higher among cases treated with pegylated interferonα+ribavirin vs. interferonα+ribavirin.
Hepatitis C: Updated Guidelines and New Drugs
Medscape Pharmacists, April 22, 2015
EASL 2015 Update
EASL 2015-RECOMMENDATIONS ON TREATMENT OF HEPATITIS C
Management of hepatitis C infection before and after liver
Aggressive treatment of hepatitis C virus (HCV) infection before cirrhosis development or decompensation may reduce LT need.
World Journal of Gastroenterology-Baishideng
Liver steatosis is defined as accumulation of lipid in the liver. In patients with chronic hepatitis C (CHC), it is frequently found as a histologic appearance.
Long-term follow-up of successful hepatitis C virus therapy: waning immune responses and disappearance of liver disease are consistent with cure
A sustained viral response (SVR) after interferon-based therapy of chronic hepatitis C virus (HCV) infection is regarded to represent a cure. Previous studies have used different markers to clarify whether an SVR truly represents a cure, but no study has combined a clinical work-up with highly sensitive HCV RNA detection, and the determination of immune responses.
Download full text article @ NATAP
The fatigue impact scale for daily use in patients with hepatitis B virus and hepatitis C virus chronic infections.
Fatigue is an important clinical finding in the hepatitis virus chronic infection. However, the absence of scales to measure fatigue, translated and validated for Brazilian Portuguese, prevents access to information essential in clarifying specific clinical conditions in this population.
Full text @ Annals of hepatology
Increased eligibility for treatment of chronic hepatitis C infection with shortened duration of therapy: Implications for access to care and elimination strategies in Canada.
All oral, highly effective direct-acting antiviral combinations, such as sofosbuvir-ledipasvir, have recently been licensed in Canada but cost as much as $67,000 for a 12-week course of therapy, representing a major economic barrier to predominately single-payer health care systems such as that found in Ontario. In hepatitis C virus (HCV) genotype 1 noncirrhotic patients with a baseline viral load of <6×106 IU⁄mL, treatment with sofosbuvir-ledipasvir can be shortened to eight weeks without compromising ≥95% efficacy. The number of HCV-infected patients in Ontario eligible for shortened therapy, and the associated cost savings, are unknown. The authors propose that treating every patient with shortened therapy, regardless of baseline viral load, would lead to significant public cost savings and collateral efficiencies, enabling increased HCV treatment capacity and cure.
Risk Factors in HIV-Infected MSM, With or Without HCV
Sexually Transmitted Infections, April 9, 2015
Genetic Variants Influence Susceptibility to HCV
BMC Infectious Diseases, April 8, 2015
Hepatitis C virus recurrence after liver transplantation: A 10-year evaluation
Impact of Physician Specialty on Quality Care for Patients Hospitalized with Decompensated Cirrhosis
Antivirals and Extrahepatic Outcomes in Patients With HCV
Gut, April 1, 2015
The Potential Role of Simeprevir for the Treatment of Hepatitis C
Future Virology, April 1, 2015
All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients with hepatitis C virus genotype 3 infection: ALLY-3 phase III study
Treatment options for patients with hepatitis C virus (HCV) genotype 3 infection are limited, with the currently approved all-oral regimens requiring 24-week treatment and the addition of ribavirin (RBV). This phase III study (ALLY-3; ClinicalTrials.gov: NCT02032901) evaluated the 12-week regimen of daclatasvir (DCV; pangenotypic nonstructural protein [NS]5A inhibitor) plus sofosbuvir (SOF; pangenotypic NS5B inhibitor) in patients infected with genotype 3. Patients were either treatment naïve (n = 101) or treatment experienced (n = 51) and received DCV 60 mg plus SOF 400 mg once-daily for 12 weeks. Coprimary endpoints were the proportions of treatment-naïve and treatment-experienced patients achieving a sustained virological response (SVR) at post-treatment week 12 (SVR12). SVR12 rates were 90% (91 of 101) and 86% (44 of 51) in treatment-naïve and treatment-experienced patients, respectively; no virological breakthrough was observed, and ≥99% of patients had a virological response (VR) at the end of treatment. SVR12 rates were higher in patients without cirrhosis (96%; 105 of 109) than in those with cirrhosis (63%; 20 of 32). Five of seven patients who previously failed treatment with an SOF-containing regimen and 2 of 2 who previously failed treatment with an alisporivir-containing regimen achieved SVR12. Baseline characteristics, including gender, age, HCV-RNA levels, and interleukin-28B genotype, did not impact virological outcome. DCV plus SOF was well tolerated; there were no adverse events (AEs) leading to discontinuation and only 1 serious AE on-treatment, which was unrelated to study medications. The few treatment-emergent grade 3/4 laboratory abnormalities that were observed were transient. Conclusion: A 12-week regimen of DCV plus SOF achieved SVR12 in 96% of patients with genotype 3 infection without cirrhosis and was well tolerated. Additional evaluation to optimize efficacy in genotype 3–infected patients with cirrhosis is underway. (Hepatology 2015;61:1127–1135)
Full text, here.
Diagnostic Performance of Magnetic Resonance Elastography in Staging Liver Fibrosis: A Systematic Review and Meta-analysis of Individual Participant Data
Full text available, here
- This is a meta-analysis of the performance of magnetic resonance elastography (MRE) for staging liver fibrosis in the setting of chronic liver disease with varied degrees of inflammation and fibrosis. In pooled analysis, MRE was 91% sensitive and 81% specific for cirrhosis. These results were primarily based on data from studies of patients with HCV (n = 328). In patients with nonalcoholic fatty liver disease (n = 115), MRE was 90% sensitive but only 76% specific.
- MRE was highly accurate for diagnosing cirrhosis and fibrosis and appears to be a valuable tool to avoid liver biopsy, but larger studies are needed to better understand test performance in different disease states and populations.
Interferon-free Treatment of Chronic Hepatitis C With Faldaprevir, Deleobuvir and Ribavirin SOUND-C3, a Phase 2b
Liver International. 2015;35(2):417-421. The safety and efficacy of the interferon-free combination of faldaprevir (NS3/A4 protease inhibitor), deleobuvir (BI 207127, non-nucleoside polymerase inhibitor), and ribavirin in treatment-naïve patients chronically infected with HCV genotype-1 was explored.
Clinical Liver Disease - New Treatments for Hepatitis C
Cirrhosis Regression in HCV Patients After Antiviral Therapy
Liver International, March 2, 2015
Chronic hepatitis C virus infection and neurological and psychiatric disorders: An overview
High prevalence of neuropsychiatric disorders has been reported in chronic hepatitis C virus (HCV) infected patients. Cerebrovascular disease, brain inflammatory disorders, cognitive symptoms, peripheral neuropathy, and psychiatric disturbs are among the multifaceted clinical manifestations occurring during chronic HCV infection....
Interferon-free Treatment for HCV Genotypes 2 and 3
Frontline Gastroenterology, February 20, 2015
Severity of liver disease among chronic hepatitis C patients: An observational study of 4594 patients in five European countries
Assessment of the severity of liver disease following infection with hepatitis C virus (HCV) is important in treatment selection and prognosis. As invasive liver biopsy procedures are regarded as the reference method to assess the stage of fibrosis, it is important to identify patient characteristics that are predictive of liver fibrosis severity. The aim of the study was to describe the distribution of liver severity scores, clinical characteristics, and physicians' assessment of fibrosis among HCV patients in five European countries. **43% had mild fibrosis
Patient-reported outcomes in chronic hepatitis C - the impact of liver disease and new treatment regimens
Genotype 1-4: Optimal Interferon-free Therapy in Treatment-experienced Chronic Hepatitis C Patients
Several recent and ongoing studies show that interferon (IFN)-free, all-oral hepatitis C virus (HCV) regimens using direct-acting antiviral (DAA) combinations can cure most chronically infected HCV patients.Yet even with these rapid advances and all-oral combinations producing sustained virological response (SVR) rates well above 90%, currently there is no one-size-fits-all treatment available. Regimen selection and treatment duration must still be decided by providers and patients. Viral factors including HCV genotype, genome targets and drug resistant variants (RAVs) must be considered in relation to host and disease factors including cirrhosis, prior treatment response, the complexity of the regimen and potential drug interactions to select the optimal regimen for each individual patient.
IFN-free Therapy in Treatment-naive Patients With HCV
Liver International, February 2, 2015
Current and Future HCV Therapy-Do We Still Need Other Anti-HCV Drugs?
The next steps in the clinical development of anti-HCV therapy are expected in late 2015–early 2016 with the availability of pangenotypic ultrarapid (4–8 weeks) single pill regimens such as Grazoprevir/MK8742, SOF/GS5816, and BMS791325/DAC/Asunaprevir.
Sofosbuvir-based regimens for HCV: SVR12 Is Equivalent to SVR24 in Assessing New HCV Regimens
Hepatology 2015 Jan - Full text
Alimentary Pharmacology & Therapeutics
Systematic review: patient-reported outcomes in chronic hepatitis C - the impact of liver disease and new treatment regimens
Background Treatment for chronic hepatitis C (CH-C) is rapidly changing and moving away from an interferon and ribavirin-based therapy to interferon-free ribavirin-free all oral regimens. These regimens are simpler and shorter to administer with very high efficacy rates and better side effect profiles. As advances in the treatment of CH-C occur, it is imperative to capture both clinical outcomes (efficacy and safety) as well as patient-reported outcomes (PROs). In fact, PROs assesses and quantifies the impact of these regimens on patient experience. PROs assess patients' health-related quality of life (HRQOL) especially in the realms of fatigue and neuropsychiatric issues such as depression which can affect treatment adherence and work productivity. Aim To review the literature related to PRO's in HCV patients and summarise the impact of CH-C and its treatment on PROs. Methods Databases Ovid MEDLINE and PubMed were searched from 1990 to October 2014 using a combination of MEsh, thesaurus terms and relevant text words: hepatitis C, CH-C, treatment, quality of life, health-related quality of life, fatigue, work productivity, adherence, patient-reported outcomes, direct acting anti-viral agents and second generation direct acting anti-viral agents. Each manuscript was assessed for pertinence to the issue of PROs in CH-C as well as the quality of study design and publications. Results From the literature, it is evident that CH-C patients have baseline PRO impairment. Furthermore, treatment with interferon with or without ribavirin and first generation DAAs causes additional PRO burden which can negatively impact treatment adherence and indirectly, treatment efficacy and work productivity. The new treatment regimens with interferon- and ribavirin-free regimens not only have very high efficacy, but also result in the improvement of PRO scores as early as 2 weeks into treatment as well as possibly better adherence to treatment regimens. Conclusions CH-C and its treatment have been associated with patient-reported outcome impairment. The new IF-free and RBV-free regimens are associated with high efficacy and substantial improvement of patient-reported outcomes in clinical trial setting. Although very encouraging, more data are needed to assess patient-reported outcomes, adherence and work productivity of CH-C patients in the real world setting of clinical practice.
Alimentary Pharmacology & Therapeutics
Successful anti-viral treatment improves survival of patients with advanced liver disease due to chronic hepatitis C
Background Long-term outcome of chronic hepatitis C patients with successful viral eradication seems to be promising. Aim To evaluate mortality, incidence of hepatocellular carcinoma (HCC), liver failure and liver transplantation in sustained virological responders (SVR) and non-SVR patients with different stages of fibrosis. Methods Seven hundred and fourteen patients with a follow-up of 7.2 (1–21.1) years (age: 51.4 ± 12.0 years, 276 female, IFN-monotherapy: n = 19, IFN/RBV: n = 122, peg-IFN/RBV: n = 573, SVR: 551, non-SVR: 163) were studied. Two hundred and ten of 540 patients with a liver biopsy prior to treatment had advanced stages of fibrosis (Metavir F3/F4). Results Forty-eight patients died during follow-up, 15 with SVR and 33 without (P < 0.001). Five- and 10-year mortality rates were 1.8% (10/551) and 2.7% (15/551) in the SVR group and 8.6% (14/163) and 19.1% (31/163) in the non-SVR patients (P < 0.001). In 29 patients, decompensation of liver disease [SVR: 9 (1.6%) vs. non-SVR: 20 (12.3%); P < 0.001] occurred and in 29 patients, HCC developed during follow-up [SVR: 10 (1.8%) vs. non-SVR: 19 (11.7%); P < 0.001]. Non-SVR was an independent predictor for developing (i) HCC [HR: 2.36 (95% CI: 1.07–5.23; P = 0.034], (ii) liver-related complications [HR: 2.62; (95% CI: 1.18–5.81; P = 0.018] and (iii) mortality (HR: 3.46; 95% CI: 1.91–6.29; P < 0.001). For patients with early stages of fibrosis (F0–F2), a survival benefit of SVR patients could not be demonstrated. Conclusions Successful anti-viral therapy decreases mortality, incidence of hepatocellular carcinoma and liver failure in patients with advanced fibrosis. However, hepatocellular carcinoma development or liver failure are not prevented completely, and further follow-up of patients is advisable.
HCV Next: HCV FORECAST 2015: New Approvals, Continued Barriers to Care
Simeprevir with peginterferon and ribavirin induced interstitial pneumonitis: First case report
This is the first report of interstitial pneumonitis that was induced by simeprevir with PEG-IFN and RBV therapy for chronic hepatitis C.
Insulin Resistance Provides the Connection Between Hepatitis C Virus and Diabetes
Sher Zaman Safi , Humaira Shah , Gracie Ong Siok Yan , Rajes Qvist
Volume 35, Issue Supplement s1, pages 1–3, January 2015
A special supplement of Liver International; Proceedings of the 8th Paris Hepatitis Conference International Conference on the Management of Patients with Viral Hepatitis, is available this month for your reading pleasure. This supplement will offer current information on both hepatitis B and hepatitis C, and include review articles on important topics such as the need for affordable universal IFN-free regimens, in addition to treatment strategies for HCV genotype 2, 4, and HCV-1b. . Additional articles include HIV/HCV co-infection, end stage liver disease, and liver cancer.
Hepatitis C Update-Treatment Of Genotypes 1,2,3,4,5,and 6
Updates from Hepatitis C Online, an interactive website from the University of Washington.
December 2014 Worth a click
A Future Without Hepatitis C?
Medscape Gastroenterology, December 16, 2014
- Current and Emerging Treatment Strategies
- Ledipasvir/Sofosbuvir (With or Without Ribavirin)
- Sofosbuvir/GS-5816; MK-5172 (Grazoprevir) and MK-8742 (Elbasvir)
- ABT-450/r, Ombitasvir, and Dasabuvir
- Defining the Long-term Benefits of Achieving SVR
- HCV Recurrence After Liver Transplantation
- Test-and-Treat Strategy
- The Economic Impact of Treatment