Review: Patient-Reported Outcomes in Chronic Hepatitis C - The Impact
of Liver Disease and New Treatment Regimens - Z. Younossi and L. Henry
Source: Alimentary Pharmacology and Therapeutics January 23, 2015
How do we measure successful
hepatitis C (HCV) treatment? Is it strictly by clinical trial data
showing how safe and effective a treatment is? Alternatively, is it by
patients’ experiences, outcomes, and overall quality of life? This
ambitious study examined patients’ experiences of living with hepatitis
C and its treatment.
They found that current data
support the fact that HCV patients suffer substantially. This burden
was much worse during interferon/ribavirin treatment and worse yet if
that treatment used telaprevir or boceprevir. The newer interferon-free
treatments showed that patients reported improvements in quality of
life and productivity; and even bigger improvements with ribavirin-free
regimens. Patients who reported easier treatment were more likely to
complete therapy and respond to it.
This study also looked at
fibrosis stage, finding significant fatigue and impairment among those
with early stage liver disease. Patients with early fibrosis reported
significant benefits, similar to the gains achieved by those with
The Bottom Line: Using
fibrosis stage to limit the cost of HCV treatment does not take in to
account the other costs of HCV, such as its effect on work
productivity, quality of life, etc.
This study validates what patients have been reporting for
decades—that having hepatitis C is hard, and that the newer treatments
offer hope for improved quality of life. Denying access to treatment
violates human rights.
Seven Years of Chronic Hepatitis C Virus Infection in an HIV-Infected
Man without Detectable Antibodies – Joost Vanhommerig, et al.
Source: AIDS 2015, Vol 29 No 3
After an HCV exposure, about half of those exposed will form antibodies in 5 to 10 weeks.
It averages 10 to 13 weeks for
HCV antibodies to be detectable in HCV/HIV-coinfected men who have sex
with men (MSM). There have been reports of some HIV-infected individuals
for whom HCV antibodies didn’t show up for more than 3 years. In this
case study, an HIV-positive man had positive HCV viral load results for
7 years but never had a positive HCV-antibody test result.
The Bottom Line: These researchers recommend HCV viral load testing rather than relying solely on antibody testing for HIV-infected MSM.
Editorial Comment: I am both fascinated and irritated when there are rare exceptions in medical science, but they do exist.
Article: Hepatitis C Virus Infection: A Risk Factor for Parkinson’s Disease – Wendy Wu, et al.
Source: Journal of Viral Hepatitis January 21, 2015
Recent evidence indicates that
HCV may invade the central nervous system. In rat studies, researchers
observed that HCV and Parkinson’s disease both overexpress
inflammatory biomarkers. Analyzing data from 62,276 subjects,
researchers found similarities between HCV and Parkinson’s.
The Bottom Line: This
study demonstrated an association between HCV infection and
Parkinson’s and confirms the observation of dopaminergic toxicity of
HCV similar to that found in rats.
Editorial Comment: As
horrifying as these results are, perhaps this research will shed light
on the nature of “brain fog,” which is experienced by so many HCV
Article: Hepatitis A hospitalizations in the United States, 2002-2011 – Melissa Collier, et al.
Source: Hepatology February 2015
This study reviewed
hospitalization rates for hepatitis A from 2002-2011. The number of
hepatitis A-related hospitalizations hasdeclined significantly, but
patients who are hospitalized for hepatitis A are older and more likely
to have liver diseases and other comorbid medical conditions.
The Bottom Line: Immunization could prevent hepatitis A infection and ensuing hospitalizations.
Editorial Comment: Hepatitis A vaccination is recommended for hepatitis C patients.
Labels: antibodies, hepatitis A, Lucinda K. Porter, Parkinson's, Patient Outcomes, snapshots, window