SNAPSHOTS —Inclusion Body Myositis | SVR & Advanced Fibrosis | HCV & Parkinson's

SNAPSHOTS —Alan Franciscus, Editor-in-Chief

Article: Hepatitis C virus infection in inclusion body myositis: A case-control study—A Uruha et al.
Source:  Neurology. 2015 Dec 18. pii: 10.1212/WNL.0000000000002291. [Epub ahead of print]

Results
The hepatitis C virus is known to cause many extrahepatic manifestations such as fatigue, muscle, and joint pain, insomnia and cryoglobulemia just to name a few.  The current study was to test to see if there was a link between the hepatitis C virus and inclusion body myositis (IBM).   IBM is a progressive group of muscle diseases.  IBM usually occurs (but not always) in people who are over 60 years old.  The researchers studied 114 patients with hepatitis C and IBM and 44 age-matched patients with polymyositis (disease of the muscle fibers) diagnosed from 2002 to 2012.  Muscle biopsies were taken and compared between the two groups.  

Conclusions 
The authors found that 28% of the patients with IBM had HCV antibodies compared to 4.5% of patients with polymyositis who had HCV antibodies and 3.4% of Japanese patients in their 60’s with polymyositis.  The authors also did not find a difference in the disease characteristics of IBM in both groups leading them to conclude that both diseases were the same (non-HCV and HCV IBM groups).
Editorial Comment
The same authors had published a smaller study in 2013 on inclusion body myositis (IBM) and HCV and came to the same conclusion.  While this does not prove that hepatitis C causes IBM, it does suggest an association. More studies are needed to find out if hepatitis C causes IBM and if treatment can arrest or reverse it.    

For more information about IBM visit: www.mda.org/disease/inclusion-body-myositis/overview

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Article:  Improvement of platelets after SVR among patients with chronic HCV infection and advanced hepatic fibrosis—A J van der Meer et al
Source:  Journal of Gastroenterology and Hepatology doi: 10.1111/jgh.13252

Study Aim and Results
One of the consequences of advanced fibrosis and cirrhosis is low platelets and enlarged spleen.   Platelets help the blood to clot and the spleen stores blood cells including platelets.  In this study, the authors reviewed studies conducted between 1990 and 2003—platelet counts of 464 patients were measured six months before treatment and 24 weeks following the end of treatment.   Of the 464 patients evaluated 353 (75%) had cirrhosis, and 187 (40%) were cured.    

Conclusions
Among the patients who were cured the platelet counts increased and the spleen size decreased—all positive signs of improvements in liver functioning.  In those who did not achieve a cure, the platelet counts decreased, and the spleen size increased – signs that the liver functioning was worsening. The authors commented that the results of this study suggested that curing hepatitis C reduces portal hypertension, increased platelet counts and reduced the size of the spleen.

Editorial Comment
The study supports treating (and curing) people with advanced hepatitis C.  Curing persons with advanced hepatitis C can improve symptoms and quality of life, and improves long-term survival. It is critical to remember, however, that HCV disease progression still occurs, and lifelong monitoring is still needed. This is why we need to treat people BEFORE their disease reaches this critical stage.

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Article:  Functional impairment in older liver transplantation candidates: From the functional assessment in liver transplantation study—C W Wang et al.
Source:  Liver Transplantation, Volume 21, Issue 12 December 2015

Study Aim and Results
Patients 65 years old and older typically have poorer liver transplant outcomes than younger patients.  The authors in the current study wanted to understand what factors could predict better outcomes in these patients other than the health issue criteria used for the Model for End-Stage Liver Disease (MELD) score to assess patients for eligibility to receive a liver transplant.  The authors used an additional battery of tests called the short physical performance battery (SPPB) test.  They tested and divided the patients into two groups—younger (under 65 years old) and older (65 years old and older).  The SPPB measures gait speed (how quickly someone could walk), chair stands (standing up from a sitting position), and balance (various balancing exercises such as standing on one foot) and graded the patients on scales as either impaired or robust.    

Conclusions 
The SPPB impaired scores at any age were more likely to die while waiting for a liver transplant.  There was no significant difference between the younger and older robust patients when it came to the risk of dying while waiting for a liver transplant.    

Editorial Comment
The logical outcome of this study is the that people with physical performance problems as listed in the SPPB should be given physical therapy instructions to improve their conditions and increase long-term survival.      

Note: If you are older (or possibly of a younger age) and have SPPB issues it makes sense to be evaluated by a medical provider and take the appropriate action.  SPPB issues (especially balance issues) are one of the most common reasons that older people fall and have severe injuries that can be life-threatening.  There are some very easy exercises that anyone can do to improve balance issues. If balance issues are more advanced talk with a medical provider, who can send you to a physical therapist who can instruct you on exercises to increase your strength and balance. The key is to start early.

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Article:  Hepatitis C virus infection as a risk factor for Parkinson disease -
A nationwide cohort study – H Tasi et al.
Source:  Published online before print December 23, 2015, doi: http://dx.doi.org/10.1212/WNL.0000000000002307Neurology 10.1212/WNL.0000000000002307  

Study Aim and Results
The study was to find out if hepatitis C is a risk factor for developing Parkinson’s disease.  The researchers searched the Taiwan National Health Insurance Research Database for the period 2000 to 2010.  There were 49,967 people with viral hepatitis (hepatitis B and hepatitis C) patients included in their analysis and 199,868 patients without viral hepatitis were included for comparison.    

Conclusions 
The analysis found that there was a significant increase risk for Parkinson’s disease for those with HCV, but not those with hepatitis B.  The increase occurred even after the researchers adjusted for age, sex and other conditions or diseases that patients with hepatitis C may have had.    

Editorial Comment
I saw this study abstract a couple of months ago, but I wanted to find out more about the study before I wrote about it.  The story was recently picked up by many news outlets, which, of course, made the study results even scarier.  

It is important to remember this study proves that there is an association but does not prove causation.  In other words—while this is a well-designed study it shows an association between hepatitis C and Parkinson’s disease.  The study does not prove that hepatitis C causes Parkinson’s disease.  More studies are needed with hepatitis C.

However, until this is proven (or not), it is critical that everyone with hepatitis C is treated and cured of HCV and the associated extrahepatic manifestations that just may include Parkinson disease.

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