Wednesday, November 15, 2017

Blog Updates Around The Web: Does an SVR to Therapy for HCV-associated Cirrhosis Reduce Portal Pressure?

Viral Hepatitis Updates
With Thanksgiving just around the corner, and Christmas on the way, it's a busy time of the year, hopefully you'll save some time online with this quick summary of blog and journal updates. 
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AGA Journals BLOG
Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology. She has worked as an editor at biomedical research journals and as a science writer for 15 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.

Does an SVR to Therapy for HCV-associated Cirrhosis Reduce Portal Pressure?
A sustained virologic response (SVR) to all-oral therapy in patients with hepatitis C virus (HCV)-associated cirrhosis significantly reduces the hepatic venous pressure gradient (HVPG), researchers report in the November issue of Gastroenterology. Nevertheless, almost 80% of patients maintain significant portal hypertension and have a continued risk of decompensation.
Continue reading...
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Clinical Care Options CCO
Mission Statement - To optimize clinicians’ competence with the goal of improving patient care through the development of educational solutions that address the explosion of new medical information and the overwhelming task of its assimilation by clinicians, with easy-to-use, innovative, interactive educational and decision support models that can be used at the point of care and provide the latest evidence-based information whenever, wherever, and however it is needed.

Hepatology Meeting Shed Light on the Clinical Benefits of HCV DAAs
Jordan J. Feld, MD, MPH - 11/14/2017 Clinical Thought 
For the first time in several years, we did not see the presentation of dramatic data from phase III trials of emerging investigational HCV therapies at the American Association for the Study of Liver Diseases (AASLD) meeting. What we learned is that we likely now have the full complement of direct-acting antivirals (DAAs) and—unfortunately—that some relatively promising regimens that were in clinical development are unlikely to come to clinical use.

What did emerge at the meeting were several studies that provided critical evidence that treatment with DAAs leads to important clinical benefits for patients with HCV infection. Although these types of studies can feel like something of a foregone conclusion, they are actually critical for payers, policymakers, and clinicians to be confident that contemporary HCV therapies are associated with the intended benefits.

*Free registration required
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On Twitter
The Cochrane Review Conclusion for Hepatitis C DAA Therapies Is Wrong

*Article shared by Henry E. Chang‏ today on Twitter.



Full Text Articles
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C.

On The Blog
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HepCBC
HepCBC is a non-profit organization run by and for people infected and affected by hepatitis C. Our mission is to provide education, prevention and support to those living with HCV.

Read today's news or check out the latest issue of: Weekly Bull
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CATIE Blog
The CATIE Blog is a unique opportunity for individuals to express a wide latitude of opinion on a range of issues. The views expressed in the blog are solely those of the authors and do not necessarily reflect the policies or opinions of CATIE nor the views of its funders

Eliminating viral hepatitis is possible: Four lessons from the World Hepatitis Summit
By Melisa Dickie
As deaths from many communicable diseases continue to decline globally, deaths caused by viral hepatitis have now surpassed all other chronic infectious diseases, including HIV/AIDS, malaria and tuberculosis. Yet it is one of the few global health threats with easy solutions. Highly effective vaccines exist for hepatitis A and B. We now have a cure for hepatitis C. With these tools at our disposal, why aren’t we seeing an impact on the epidemic?
Continue reading....
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National Viral Hepatitis Roundtable
The National Viral Hepatitis Roundtable is a broad coalition working to fight, and ultimately end, the hepatitis B and hepatitis C epidemics. We seek an aggressive response from policymakers, public health officials, medical and health care providers, the media, and the general public through our advocacy, education, and technical assistance.

Why We Need a Movement for Racial Justice and Health Equity in Order to Eliminate Hepatitis B and Hepatitis C
by the National Viral Hepatitis Roundtable’s Steering Committee
Recently, some people have questioned why the National Viral Hepatitis Roundtable’s staff and members of its Steering Committee have made statements in words and action standing up for racial justice. We hope this statement provides additional context for why speaking out about the need for racial justice and health equity is critical to the hepatitis B and hepatitis C response.

NVHR Welcomes New Hepatitis B Vaccine
NVHR today welcomed the U.S. Food and Drug Administration’s (FDA) approval of HEPLISAV-B for prevention of hepatitis B virus infection in adults ages 18 and older.
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Médecins Sans Frontières/ Doctors Without Borders (MSF)
Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation. We offer assistance to people based on need, irrespective of race, religion, gender or political affiliation. Our actions are guided by medical ethics and the principles of neutrality and impartiality.

Fighting Hepatitis in Cambodia: Medical Week

"The best part of Medical Week was the opportunity to meet MSF colleagues from all over the world, most of whom had more experience than I have and who had lots of advice for me, such as..."
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POZ
POZ is an award-winning print and online brand for people living with and affected by HIV/AIDS. Offering unparalleled editorial excellence since 1994, POZ magazine and POZ.com are identified by our readers as their most trusted sources of information about the disease.

Finding Folks Who Have HIV or Hep C in an Opioid-Ravaged Region
West Virginia has been hit hard by the opioid epidemic, so it is important to identify people living with HIV and hepatitis C virus (HCV), which can be spread by injection drug use. A four-year $1.375 million grant aims to do exactly that. Funding goes to the West Virginia University (WVU) School of Medicine’s Department of Emergency Medicine and arrives from Frontlines of Communities in the United States (FOCUS), an initiative of pharma giant Gilead Sciences.
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HEPATITISC.NET
At HepatitisC.net we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.

Elimination: What Does It Look Like?
By Daryl Luster—November 14, 2017
Elimination. There’s a kind of ominous ring this word, but this is what we hear a lot in the world of viral hepatitis, including HBV and HCV. The meaning here is meant to describe a global effort to eliminate hep C as a health threat. With estimates of worldwide infection ranging wildly, suffice to say it is well over 100 million people now living with hep C. Some peg it at around 150-170 million, and no matter which is accurate it is a huge number.
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Hepatitis B Foundation
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide. Our commitment includes funding focused research, promoting disease awareness, supporting immunization and treatment initiatives, and serving as the primary source of information for patients and their families, the medical and scientific community, and the general public.

Diagnosing Hepatitis Delta in the U.S.
November 15, 2017 hepbtalk
Hepatitis D, or hepatitis delta, is the most severe form of viral hepatitis known to humans. The hepatitis D virus infects the liver and is dependent on the hepatitis B virus to reproduce. This means that people who are already infected with hepatitis B are at risk of contracting hepatitis D as well.
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MD Magazine
MD Magazine is a comprehensive clinical news and information portal that provides physicians with up-to-date specialty and disease-specific resources designed to help them provide better care to patients.

Aspirin Could Reduce HBV Patients' Liver Cancer Risk
Patients with chronic hepatitis B virus (HBV) who take an aspirin a day may reduce their risk of hepatocellular carcinoma (HCC), the most common form of adult liver cancer, a new study suggests.
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Medscape
Medscape is the leading online global destination for physicians and healthcare professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and CME.

Preventing Perinatal Transmission of Hepatitis B
November 14, 2017
 Dr William Balistreri surveys the latest guidelines and studies aiming to improve maternal and neonatal outcomes.
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Kaiser Family Foundation
Kaiser Health News (KHN) is a nonprofit news service committed to in-depth coverage of health care policy and politics. And we report on how the health care system — hospitals, doctors, nurses, insurers, governments, consumers — works.

Vaccine Shortage Complicates Efforts To Quell Hepatitis A Outbreaks
By Stephanie O'Neill
San Diego County, battling a deadly outbreak of hepatitis A, is postponing an outreach campaign to provide the second of two inoculations against the contagious liver disease until a national shortage of the vaccine is resolved, the county’s chief public health officer said. “Our goal is to get that vaccine in as many arms as possible for that first dose,” said Dr. Wilma Wooten, who is leading the fight against an epidemic that has ravaged unsanitary homeless encampments in San Diego County for the past year, sickening 544 people and killing 20 of them as of Nov. 6.
Continue reading.......
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Harvard Health Blog
Harvard Health Publishing is the media and publishing division of the Harvard Medical School of Harvard University, under the direction of Dr. Gregory Curfman, Editor in Chief. The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.

Seasonal Influenza
What’s new with the flu shot?
Posted November 13, 2017, 10:30 am
Dominic Wu, MD, Contributing Editor
Should you get the influenza (flu) vaccine this year? The short, quick answer (barring any medical reasons you shouldn’t, such as severe allergies), is yes! But recent research raises another important question: When should you get the shot?
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Healio
Healio.com features the industry’s best news reporting, dynamic multimedia, question-and-answer columns, CME and other educational activities in a variety of formats, quick reference content, blogs, peer-reviewed journals and a full line of popular book titles.

Welcome to the New World Order A Competitive HCV Drug Marketplace
November/December print edition of HCV NEXT, available online at Healio.
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MPR
Monthly Prescribing Reference (MPR) is a multispecialty drug information resource for healthcare professionals offering concise prescribing information, point-of-care tools, as well as news and features on hot topics in pharmacotherapy.

Labeling for Several HCV Drugs Updated With New Drug Interactions
Specifically, the prescribing information for Viekira Pak (ombitasvir, paritaprevir, ritonavir, with dasabuvir; AbbVie), Viekira XR (dasabuvir, ombitasvir, paritaprevir, ritonavir; AbbVie), Technivie (ombitasvir, paritaprevir, ritonavir; AbbVie), Sovaldi (sofosbuvir; Gilead), Harvoni (ledipasvir, sofosbuvir; Gilead), Epclusa (sofosbuvir, velpatasvir; Gilead), Vosevi (sofosbuvir, velpatasvir, voxilaprevir; Gilead), Olysio (simeprevir; Janssen), Daklinza (daclatasvir; Bristol-Myers Squibb), and Zepatier (elbasvir, grazoprevir; Merck) has been updated to include information pertaining to changes in International Normalized Ratio (INR) values in patients receiving warfarin. Fluctuations in INR values may occur in patients receiving warfarin concomitant with HCV treatment.
Read more..... 
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Journal Updates
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PLOS ONE
The world’s first multidisciplinary Open Access journal, PLOS ONE accepts scientifically rigorous research, regardless of novelty. PLOS ONE’s broad scope provides a platform to publish primary research, including interdisciplinary and replication studies as well as negative results. The journal’s publication criteria are based on high ethical standards and the rigor of the methodology and conclusions reported.

Evolution of acute hepatitis C virus infection in a large European city: Trends and new patterns
The aims of this study were to describe the evolution of acute hepatitis C virus (HCV) infections since 2004 and to determine its associated factors. Acute HCV infections diagnosed in Barcelona from 2004 to 2015 were included. Incidence ratios (IR) were then estimated for sex and age groups. Cases were grouped between 2004–2005, 2006–2011 and 2012–2015, and their incidence rate ratios (IRR) were calculated. In addition, risk factors for acute HCV infection were identified using multinomial logistic regression for complete, available and multiple imputed data. 204 new HCV cases were identified. Two peaks of higher IR of acute HCV infection in 2005 and 2013 were observed. Men and those aged 35–54 had higher IR. IRR for men was 2.9 times greater than in women (95% confidence intervals (CI): 1.8 ‒ 4.7). Factors related to the period 2012–2015 (versus 2006–2011) were: a) sexual risk factor for transmission versus nosocomial (relative-risk ratio (RRR): 13.0; 95% CI: 2.3 ‒ 72.1), b) higher educated versus lower (RRR: 5.4; 95% CI: 1.6 ‒ 18.7), and c) HIV co-infected versus not HIV-infected (RRR: 53.1; 95% CI: 5.7 ‒ 492.6). This is one of the few studies showing IR and RRRs of acute HCV infections and the first focused on a large city in Spain. Sexual risk for transmission between men, higher educational level and HIV co-infection are important factors for understanding current HCV epidemic. There has been a partial shift in the pattern of the risk factor for transmission from nosocomial to sexual.
Continue to full text article........

Sex difference in the interaction of alcohol intake, hepatitis B virus, and hepatitis C virus on the risk of cirrhosis.
Stroffolini T, et al. PLoS One. 2017
Abstract
BACKGROUND: The joint effect of the interaction of alcohol intake, hepatitis B virus (HBV) and hepatitis C virus (HCV) on the risk of cirrhosis is still unexplored because a large sample size is required for this investigation.

OBJECTIVE: Evaluation of interaction of HBV, HCV and alcohol abuse on the risk of cirrhosis.
DESIGN: We analysed 12,262 consecutive patients with chronic liver disease of various aetiologies referring to 95 Italian liver units in 2001 or 2014. To evaluate the interaction between alcohol abuse, HBV infection, and HCV infection, patients unexposed to either factors were used as reference category. Adjustment for BMI and age was done by multiple logistic regression analysis.
RESULTS: Females were older than males (p<0.01) and less frequently showed HBV and alcoholic aetiology (p<0.01). In both sexes, an overtime increasing age and an increasing proportion of subjects with liver cirrhosis was observed, reflecting a better survival (0.01). An additive interaction is observed in females: the O.R. generated by the simultaneous presence of HBV, HCV, and alcohol (5.09; 95% C.I. 1.06-24.56) exceeds the sum (4.14) of the O.R. generated by a single exposure (O.R. = 0.72 for HBsAg positivity, OR = 1.34 for anti-HCV positivity, and O.R. = 2.08 for alcohol intake). No interaction is observed in male sex.
CONCLUSIONS: The observed gender difference suggests that the simultaneous presence of HBV/HCV coinfection and risky alcohol intake enhances the mechanism of liver damage to a greater extent in females than in males.
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The Lancet
The Lancet began as an independent, international weekly general medical journal founded in 1823 by Thomas Wakley. Since its first issue (October 5, 1823), the journal has strived to make science widely available so that medicine can serve, and transform society, and positively impact the lives of people.

Eliminating viral hepatitis: time to match visions with action

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Of Interest
AMI Podcast - November 13, 2017 episode
2017 World Hepatitis Summit

Hepatitis C in Canada

Dr. Jordan Feld from the Toronto Centre for Liver Disease discuss what it will take for hepatitis C to be cured in Canada.

Of all infectious disease in Canada the one disease that causes most years of life lost is hepatitis C. 
Listen here......

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