Snapshots—December 15, 2014, by Alan Franciscus

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:
Editorial Comment:  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.

Abstract:  Long-term 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. 

Editorial comment:  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. 

Abstract:  Clinical 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 hepatitis A.

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