Abstract: Pathogenesis and prevention of hepatitis C virus-induced hepatocellular carcinoma—Y. Hoshida et al.
Source: J Hepatol.2014 Nov;61(1S):S79-S90. doi: 10.1016/j.jhep.2014.07.010. Epub 2014 Nov 3.
One of the major causes of
hepatocellular carcinoma (HCC) or liver cancer is hepatitis C (HCV).
HCV can lead to liver inflammation, fibrosis, and cirrhosis. After the
development of fibrosis and cirrhosis, liver cancer can develop.
Given the large population of people with hepatitis C worldwide and the
on-going progression and aging of the hepatitis C population, the rate
of liver cancer is going to increase dramatically in the coming years.
At this time, there are very limited treatment options to treat it and
extend the life of patients suffering from this horrific condition.
The authors noted that:
Researchers need to understand the relationship between the hepatitis C virus and liver cancer (how the virus causes it), and
Develop more effective therapies to prevent and treat liver cancer
Developing treatments for HCV-related liver cancer should be a
high-priority for researchers and pharmaceutical companies. The “High
Priority” recommendation of HCV treatment for people with severe
fibrosis/cirrhosis is a no-brainer. We also know that treating
individuals with severe disease does not necessarily prevent liver
cancer (although the risk is greatly reduced). However, treating
individuals that have mild or no fibrosis prevents liver cancer. Does
this strike anyone as counterproductive to good medicine? This is
another good reason to be proactive with regard to treatment—I look
forward to reading the HealthWise article “Denied Hepatitis C
Treatment? Here is How to Fight Back” in the January 2015 HCV Advocate newsletter.
effect of HCV eradication in patients with mixed cryoglobulinemia: A
prospective, controlled, open-label, cohort study—L. Gragnani et al.
Source: Hepatology.2014 Nov 27. doi: 10.1002/hep.27623. [Epub ahead of print]
The study had 121 HCV patients
with symptomatic cryoglobulinemia; 132 asymptomatic cryoglobulinemia
patients and 158 HCV patients without cryoglobulinemia. The patients
in the study were treated with pegylated interferon plus ribavirin per
standard treatment duration. The post-treatment follow-up period was
35 to 124 months. Cryoglobulinemia was found to be a negative
predictor to treatment response—that is the patients who had
cryoglobulinemia were less likely to be cured with pegylated interferon
plus ribavirin. In all the patients who achieved a cure the symptoms
either improved or completely disappeared. In 36 (57%) patients with
cryoglobulinemia who were treated and cured the symptoms of
cryoglobulinemia disappeared. Cryoglobulinemia symptoms persisted in
only 2 patients (3%) who were cured with HCV treatment.
Cryoglobulinemia symptoms persisted in all of the patients who did not
achieve a cure with HCV treatment.
This is the largest clinical trial that I have been able to find on
treatment of cryoglobulinemia. It is important to show that curing HCV
will cure cryoglobulinemia in most people who are treated. Perhaps it
would be wise to change the AASLD/IDSA treatment guidelines to include a
recommendation for treatment of all HCV-related cryoglobulinemia
patients—as they say to “nip it in the bud.” I would like to see
another large clinical trial of this size of all oral therapy of HCV to
treat cryoglobulinemia to establish the need and raise more awareness
of this extrahepatic manifestation of HCV.
outcomes of hepatitis B virus coinfection in a United States cohort of
hepatitis C virus-infected patients—R Kruse et al.
Source: Hepatology Issue published online: 24 NOV 2014
The aim of this study was to
understand the rate of hepatitis B (HBV) infection in people infected
with hepatitis C (HCV)—HBV/HCV coinfection. The study analyzed a
database from the National Veterans Affairs HCV Clinical Case Registry
to find confirmed HCV cases during the period 1997 through 2005. The
records of 99,548 people with HCV were analyzed for information about
HBV infection, cirrhosis, liver cancer, and death. The analysis found
only 1,370 (1.4%) confirmed HBV infections. Of those with HBV
coinfection 677 (49%) of the patients had an HBV DNA (viral load) test.
Those with HBV DNA had a
significantly higher risk of cirrhosis, liver cancer and death compared
to the people with HCV mono-infection. Importantly, people with
undetectable HBV DNA had a similar risk of complications as those
mono-infected with HCV.
Editorial Comment: The
rate of HBV/HCV coinfection is significantly lower than expected.
However, the fact that only half of the patients received follow-up HBV
DNA testing is problematic, especially considering the potential for
considerable complications of HBV/HCV coinfection. Since HCV and HBV
share some transmission routes I would like to ask this question: Have
YOU been tested for HBV and HCV? If you are
unsure—check with your medical provider. At the very least, you
should be tested and, if you are not immune, get vaccinated for HBV and
Labels: cryoglobulinemia, HBV-HCV Coinfection, Liver cancer HCC, snapshots