Prevalence and risk factors for patient-reported joint pain among
patients with HIV/Hepatitis C coinfection, Hepatitis C monoinfection,
and HIV monoinfection—A Ogdie et al.
Source: BMC Musculoskeletal Disorders 2015, 16:93 doi:10.1186/s12891-015-0552-z
A common symptom that people with hepatitis C
report is pain—liver pain, muscle and joint pain, fibromyalgia,
headaches and the list goes on and on. The aim of the current study
was to determine the prevalence of patient reported joint pain among 3
groups (a total of 202 patients, mostly males): HCV mono-infection (93
patients); HIV-mono-infection (30 patients); and HIV/HCV co-infection
(79 patients). The ages and genders were similar across all three
groups. More than half were Black.
The Multi-Dimensional Health Assessment
Questionnaire was used to determine joint pain and any related
symptoms. The patients were also interviewed and their charts were
The Bottom Line: Joint pain was
more commonly reported in HCV-monoinfected patients than in
HIV/HCV-coinfected patients—71% vs. 56. Joint paint was also more
commonly reported in HCV mono-infected patients than in HIV-monoinfected
patients—71% vs 50%.
The study found that a previous diagnosis of
arthritis and current smoking were risk factors for joint pain among
people who are infected with hepatitis C.
Editorial Comment: This is
another reason why everyone with hepatitis C should be treated. There
are so many symptoms and conditions caused by hepatitis C.
Liver-related death among HIV/hepatitis C virus-co-infected individuals:
implications for the era of directly acting antivirals—D Grint et al.
Source: AIDS. 2015 Apr 13. [Epub ahead of print]
The new interferon-free therapies provide similar
cure rates in people who are co-infected with HIV and hepatitis C as
in people who are mono-infected with hepatitis C. However, access is
being restricted due the higher costs of the newer medications.
In general, people who are co-infected with HIV
and hepatitis C have a faster rate of HCV disease progression than
someone with hepatitis C mono-infection. Even so, treatment is being
restricted to those with the greatest risk of liver-related death. The
current study sought to provide a degree of guidance on who should be
prioritized for receiving the new direct acting antiviral medications
(DAAs) or HCV inhibitor combination medications. The study looked at
the liver-related deaths of the people who were co-infected with HIV
and hepatitis C.
In the current study 3,941 HCV antibody positive
patients who were part of a European study (EuroSIDA) and who were
followed-up after 1 January 2000 were included.
Liver-related deaths accounted for 145 of 670
(21.6%) deaths in the study population. Liver-related death rates
peaked in those aged 35-45 years, and occurred almost exclusively in
those with at least F2 fibrosis at baseline. Note: The
Metavir scale is F0, no activity, F1 for inflammation, F2 for light
scarring, F3 for moderate-severe scarring and F4 for cirrhosis.
The Bottom Line: The authors
reported that the 5- year probability of liver related death (LRD) was
low for those with F0-F1, but substantial for those F2, F3 and F4.
The authors also noted that “treatment with DAAs
should be prioritized for those with at least a F2 fibrosis. Early
initiation of cART with the aim of avoiding low CD4 cell counts should
be considered essential to decrease the risk of LRD and the need for
Editorial Comment: I wonder how
many people coinfected with HIV/HCV are F0-F1, how quickly people
progress from one stage to another, how often do you need to monitor
people in stage F0/F1, how much does it cost to monitor, and would it
be cheaper in the long run to treat everyone?
Article: Hepatitis A and B among young persons who inject drugs—Vaccination, past, and present infection. MG Collier et al.
Source: Vaccine. 2015 Apr 15. pii: S0264-410X(15)00472-7. doi: 10.1016/j.vaccine.2015.04.019. [Epub ahead of print]
It is recommended that people who inject drugs
(PWID) should be vaccinated against hepatitis A (HAV) and hepatitis B
(HBV). There is some evidence that some young individuals who were
vaccinated as children may have lost their immunity. The current
study sought to understand the current HAV and HBV immunity status among
519 persons who inject drugs. The study group included 18 to 40
year olds who lived in San Diego—49% were non-Hispanic white, 7% were
non-Hispanic Blank, 27% were White Hispanic, 4% were born outside of
The Bottom Line: After being
tested it was found that 47% were susceptible to HBV infection and 63%
were susceptible to hepatitis A infection. Additionally, 26% tested
positive for HCV antibodies. The authors reported that even though the
participants believed that they had been vaccinated, many had not. The
authors commented that "Programs serving this population should
vaccinate PWIDs against HAV and HBV and not rely on self-report of
Editorial Comment: This recommendation makes
perfect sense. People forget about what vaccines they received as
children or if they were vaccinated at all. If you have hepatitis C it
is even more important to be protected. Becoming co-infected with
another hepatitis virus such as HAV or HBV can lead to serious health
consequences, even death. The HAV vaccine can be given without
serologic testing since it will do no actual harm. It is important,
however, to give the HBV serologic test to make sure that people are
not already infected with the hepatitis B virus before giving the HBV
vaccine. The HBV vaccine doesn’t provide any benefit to people who
have acute or chronic HBV and might just might give people a false
sense of security and prevent much needed follow-up medical care.
Labels: Coinfection, HAV, HBV, joint pain, liver-related death, monoinfection, pwid