Snapshots —Lucinda K. Porter, RN

Article: Next-Generation Sequencing Sheds Light on the Natural History of Hepatitis C Infection in Patients Who Fail Treatment – Tamer Abdelrahman, et al.
  Source: Hepatology January 2015; Volume 61, Issue 1, pages 88–97

Reports show high rates of HCV reinfection among injecting drug users with history of HCV, along with reports of sexually transmitted HCV infection and reinfection in HIV-infected men who have sex with men. This research investigated viral quasispecies dynamics in patients who failed HCV treatment to determine whether treatment failure was associated with reinfection or reemergence of preexisting infection. Previous studies interpreted the evidence as reinfection; this study identified the subjects as having preexisting resistant HCV variants.

 

The Bottom Line: Resistant HCV strains are more likely the reason for failure to achieve a sustained virological response (SVR) in these study subjects. This could be the result of superinfection or a limitation on the ability to test these HCV strains.

 

Editorial Comment: Few words cause as much fear in me as “superinfection.” What this study did not discuss is whether the lack of SVR could be connected to immune factors in this study group.

Article: Association between Chronic Hepatitis C Virus Infection and Low Muscle Mass in US Adults – Charitha Gowda, et al.
  Source: Journal of Viral Hepatitis December 2014; Volume 21, Issue 12, pages 938–943

The purpose of this cross-sectional study was to see if chronic hepatitis C virus (HCV) infection was associated with low muscle mass among adults.

Among 18,513 adults in the U.S., people with chronic HCV had a higher prevalence of low muscle mass compared to uninfected persons (13.8% vs. 6.7%). Even HCV+ persons without significant liver fibrosis had lower muscle mass.

 

The Bottom Line: Chronic HCV infection is associated with low muscle mass, even in the absence of advanced liver disease.

 

Editorial Comment: Low muscle mass is a risk factor for osteoporosis. This study strengthens the argument that we should treat people with chronic HCV, regardless of fibrosis stage.  

Article: The Epidemiology of Cirrhosis in the United States: A Population-based Study – Steven Scaglione, et al.
  Source: Journal of Clinical Gastroenterology published ahead-of-print October 8, 2014

Hepatitis C is one of many conditions that can cause cirrhosis, a severe scarring of the liver. This study assessed the prevalence of cirrhosis in the US, and defined some of the characteristics of this potentially deadly condition.

The prevalence of cirrhosis is higher in the U.S. than previously estimated (633,323 now versus previously estimated 400,000 adults). The researchers believe that the prevalence is even higher since this research relied on data from the NHANES survey, which did not collect data from people who were in the military, prison, hospitalized, homeless, or institutionalized.

Alcohol abuse, diabetes and hepatitis C were contributing factors for the majority of those with cirrhosis.  Non-Hispanic blacks and Mexican Americans, those living below the poverty level, and those with less than a 12th grade education had the highest prevalence of cirrhosis. Nearly 70% of those who have cirrhosis may not know they have it.

 

The Bottom Line: The prevalence of cirrhosis is significantly higher than previously thought.

 

Editorial Comment: The most common factors associated with cirrhosis are preventable – hepatitis C, diabetes, and alcohol abuse. Hepatitis C is curable; a public health program that identifies and cures this virus may reduce the burden of cirrhosis.

Article: Cognitive Function and Endogenous Cytokine Levels in Children with Chronic Hepatitis C – N. H. Abu Faddan, et al.
  Source: Journal of Viral Hepatitis published ahead-of-print December 15, 2014

Hepatitis C is rarely studied in children, and little is known about the cognitive effects of hepatitis C in young patients. This Egyptian study compared cognitive function in 35 HCV-positive children to 35 HCV-negative children. Compared to HCV-negative children, the children with HCV had reduced function in the areas of vocabulary, comprehension, memory, abstract visual reasoning test, quantitative reasoning test, and intelligence quotients.

 

The Bottom Line: Children with chronic HCV in its early stages showed signs of cognitive impairment, particularly with memory. There appeared to be a correlation between cognitive function and immune response as measured by the production of cytokines.

 

Editorial Comment: This study is particularly heart breaking. Children are often the last to be studied, and the last to be treated. We tend to be afraid to treat children, understandably concerned that we may injure them. This study represents the tip of the iceberg, telling us how little we know about HCV in children.

 

Article: Impact of Hepatitis C Virus Infection on the Risk of Death of Alcohol-Dependent Patients – Daniel Fuster, et al.
  Source: Journal of Viral Hepatitis January 2015; Volume 22, Issue 1, pages 18–24

This longitudinal research assessed the relationship between chronic hepatitis C virus (HCV) infection and survival rates. There were 675 subjects (nearly 80% male), enrolled in two detoxification units, with a median follow-up of three years. 

The Bottom Line: The mortality rate was high for those with alcohol-related liver disease, regardless of HCV-status; more than 11% died (78 subjects). Risk of death was increased among younger HCV-positive participants compared to those who were HCV-negative. HCV/HIV co-infection was associated with increased risk of death.