Model Explains Efficacy of HIV Drugs

By Michael Smith, North American Correspondent, MedPage Today

Published: February 19, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Any HIV therapy that reduces the risk of an immune cell being infected by a factor of at least 100,000 is enough to keep the virus in check, researchers reported.

The finding, from a detailed mathematical model of antiviral activity, suggests why some drugs and drug combinations do better than others, according to Robert Siliciano, MD, PhD, of Johns Hopkins University in Baltimore and colleagues.

And the model also demonstrated that the complexity and cost of HIV treatment might be reduced -- and access to treatment improved -- by choosing drugs based on their ability to inhibit infection, Siliciano and colleagues reported online in Nature Medicine.

In principle, it might even be possible to move to dual therapy or even monotherapy, if the inhibition remained high enough, Siliciano told MedPage Today. "There are trials of (protease inhibitor) monotherapy already, with reasonably good results," he wrote in an email.

The key to the model, the researcher said, is understanding how well individual drugs block the infection of immune cells in a single round of replication and then calculating what happens to the inhibition when drugs are combined.

In some combinations, the individual effects are nearly independent of each other, increasing the power of the regimen as a whole, the researchers reported.

In others, the drugs share a common target and their effects add up, but not as much as might be expected, they found.

For this analysis, the researchers calculated the instantaneous inhibitory potential (IIP) of a range of commonly used drugs and combinations. IIP is a useful and intuitive measure of antiviral activity, the authors explained.

They defined the IIP as the log reduction in infected cells caused by a drug or combination.

Among the surprises, Siliciano said, was the fact that the IIP varied widely among drugs.

For instance, one of the earliest anti-retrovirals -- the nucleoside analogue reverse transcriptase inhibitor stavudine (or d4T) -- had an IIP of less than one log.

In contrast, the boosted protease inhibitor darunavir (Prezista) had an IIP of about 10 logs by itself, while the combination of darunavir and efavirenz (Sustiva), had an IIP of about 12 logs.

Overall, the researchers reported, a drug or regimen can be effective if its IIP is between five and eight logs.

But of 31 regimens evaluated, only one with an IIP of less than eight was able to reduce the viral load to undetectable in 70% of patients after 48 weeks.

"Overall, the results fit well with clinical results," Siliciano said.

The work could help refine anti-HIV strategy, which for years has focused in attacking different aspects of the viral life cycle. In most cases, the approach worked but it wasn't clear why come combinations worked and others did not.

"What this work does is explain why some combinations work and others don't," Siliciano said.

There no immediate clinical application of the work, but it will help in "shaping future clinical research questions," Siliciano said.

The study was supported by the NIH and the Howard Hughes Medical Institute.

The journal said the authors declared no competing financial interests.

Primary source: Nature Medicine
Source reference:
Jilek BJ, et al. "A quantitative basis for antiretroviral therapy for HIV-1 infection" Nature Medicine 2012; DOI: 10.1038/nm.2649.

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New Protease Inhibitors for the Treatment of Chronic Hepatitis C

A Cost-Effectiveness Analysis

Shan Liu, SM; Lauren E. Cipriano, BSc, BA; Mark Holodniy, MD; Douglas K. Owens, MD, MS; and Jeremy D. Goldhaber-Fiebert, PhD

Abstract

Background: Chronic hepatitis C virus is difficult to treat and affects approximately 3 million Americans. Protease inhibitors increase the effectiveness of standard therapy, but they are costly. A genetic assay may identify patients most likely to benefit from this treatment advance.

Objective: To assess the cost-effectiveness of new protease inhibitors and an interleukin (IL)–28B genotyping assay for treating chronic hepatitis C virus.

Design: Decision-analytic Markov model.

Data Sources: Published literature and expert opinion.

Target Population: Treatment-naive patients with chronic, genotype 1 hepatitis C virus monoinfection.

Time Horizon: Lifetime.

Perspective: Societal.

Intervention: Strategies are defined by the use of IL-28B genotyping and type of treatment (standard therapy [pegylated interferon with ribavirin]; triple therapy [standard therapy and a protease inhibitor]). Interleukin-28B–guided triple therapy stratifies patients with CC genotypes to standard therapy and those with non-CC types to triple therapy.

Outcome Measures: Discounted costs (in 2010 U.S. dollars) and quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios.

Results of Base-Case Analysis: For patients with mild and advanced fibrosis, universal triple therapy reduced the lifetime risk for hepatocellular carcinoma by 38% and 28%, respectively, and increased quality-adjusted life expectancy by 3% and 8%, respectively, compared with standard therapy. Gains from IL-28B–guided triple therapy were smaller. If the protease inhibitor costs $1100 per week, universal triple therapy costs $102 600 per QALY (mild fibrosis) or $51 500 per QALY (advanced fibrosis) compared with IL-28B–guided triple therapy and $70 100 per QALY (mild fibrosis) and $36 300 per QALY (advanced fibrosis) compared with standard therapy.

Results of Sensitivity Analysis: Results were sensitive to the cost of protease inhibitors and treatment adherence rates.

Limitation: Data on the long-term comparative effectiveness of the new protease inhibitors are lacking.

Conclusion: Both universal triple therapy and IL-28B–guided triple therapy are cost-effective when the least-expensive protease inhibitor are used for patients with advanced fibrosis.

Primary Funding Source: Stanford University.

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Boomers' Drug Use Pushes Hepatitis Deaths Past HIV, Study Finds

February 20, 2012 10:00 PM

Feb. 20 (Bloomberg) -- Deaths attributed to hepatitis in the U.S. rose during the past decade to surpass those from HIV, posing a future public health burden as most people aren't aware they are infected.

The baby boom generation, those born from 1946 to 1964, are the most at risk to the bloodborne virus, said John Ward, director of the Centers for Disease Control and Prevention's hepatitis division, and an author of the study.

“Injection drug use was frequent in this age group, and even one-time exposure to injection drug use carries a high risk,” Ward said in an interview. “Seventy-five percent of the mortality is in this age group, and that mortality is increasing. That's the sobering facts for the baby boom generation.”

Hepatitis is a viral infection that can cause swelling and inflammation of the liver and can lead to damage of the organ, cancer and death, according to the National Institutes of Health. The virus has different forms -- A, B and C -- which are further broken down into subgroups called genotypes.

Researchers studied 22 million death records from 1999 to 2007, finding 15,000 died from hepatitis C alone, compared with 13,000 from HIV. As many as 1.4 million people are living with chronic hepatitis B, according to the study, and 3.2 million have hepatitis C, with two-thirds born from 1946 to 1964. The results were reported today in the Annals of Internal Medicine.

‘So Little Attention'

“Few diseases of such morbidity and mortality in the United States have received so little public attention and funding as chronic viral hepatitis,” the researchers wrote in the study.

A vaccine for hepatitis B was first approved by the U.S. Food and Drug Administration in 1981, and has been recommended for all infants since the early 1990s, Ward said, eliminating its prevalence among younger generations. Hepatitis C wasn't discovered until 1989 and has no vaccine, he said.

“It's an infection that doesn't always cause you to become ill when you become infected,” Ward said. “It progresses silently over decades, and many people do not become symptomatic or sick until their liver damage is quite advanced, or they develop liver cancer, and so for those reasons, the scope of the problem is underappreciated.”

As many as 170 million people worldwide are chronically infected with the hepatitis C virus, according to the World Health Organization.

HIV Cases

While the number of people infected with HIV rose to 34 million globally in 2009, the virus that leads to AIDS, once a death sentence, can be reduced to low levels in the blood with use of combination antiviral medicines. About 1.2 million Americans have HIV, with about 43,000 new cases reported in 2008, according to the CDC.

The standard treatment for hepatitis C for the past decade has been a combination of the antiviral drug ribavirin with interferon, an immune-boosting protein sold by Merck & Co. as PegIntron and by Roche Holding AG as Pegasys. Patients receive weekly shots of Interferon for as long as a year, which can cause side effects such as fatigue and flu-like symptoms.

A new class of drugs were introduced last year called protease inhibitors, including Victrelis from Whitehouse Station, New Jersey-based Merck and Incivek by Vertex Pharmaceuticals Inc. of Cambridge, Massachusetts. These medicines attack the virus itself, and have been shown to cure more patients in less time with fewer side effects, although they still must be combined with Interferon shots.

Potential Breakthrough

A further breakthrough in treatment may come this year with the development of the experimental drug class called nucleotide polymerase inhibitors, which bind to a different part of the virus than the protease inhibitors. These drugs are pan- genotypic -- meaning they are effective across the different types of hepatitis C. They could become the backbone for an Interferon-free combination.

Abbott Laboratories, Bristol-Myers Squibb Co., Gilead Sciences Inc., Johnson & Johnson, Merck and Vertex are among the drugmakers acquiring and developing these new therapies as they seek a potential combination that may lead to a cocktail pill to control the disease, similar to the approach taken with HIV drugs.

--Editors: Andrew Pollack, Stephen West

Also See: Hepatitis C Now Killing More Americans than HIV

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Benefits of hepatitis C treatment outweigh costs for patients with advanced disease

February 20, 2012

A towering $60,000 bill, a year of fierce, flu-like symptoms and a running risk of depression are among the possible costs of two new hepatitis C treatments. But according to Stanford University health policy researchers, they might be worth it.

Using a computer model of hepatitis C disease — which accounts for different treatments, outcomes, disease stages and genetics — a research team led by Jeremy Goldhaber-Fiebert, PhD, found that new triple-therapies for genotype-1 hepatitis C are cost-effective for patients with advanced disease. Their results will be published Feb. 21 in the Annals of Internal Medicine.

"With so many simultaneous factors, it's very hard to know what to do," said Shan Liu, a graduate student in management science and engineering in the School of Engineering and lead author of the study. "I think building models is a very eloquent and abstract way to inform difficult policy decisions."

Nearly 4 million people in the United States are infected with genotype-1 hepatitis C — a virus that attacks the liver, causing swelling, scarring, cancers and the need for transplants. Many of those infected are age 50 or older, meaning they may have long-term infections and could face serious hepatitis C-related diseases. Unlike hepatitis B, there is no vaccine for hepatitis C. Until last summer, hepatitis C treatments were a gamble with many side effects, including anemia, vomiting, hair loss and depression.

"These treatments are very uncomfortable and long — up to 48 weeks," said Goldhaber-Fiebert, assistant professor of medicine at the School of Medicine. "Many people likened the experience to cancer chemotherapy: hard to undergo if the chance of treatment success is not that high."

With an impending spike in illnesses among the hepatitis-C-infected population in the United States, researchers and physicians have been developing new tests and treatments. For instance, researchers recently identified a specific DNA sequence in the gene that codes an immune response regulator, called IL28b. Different IL28b sequences predict whether treatment will successfully clear the virus.

The latest in a series of improved therapies — and the focus of the study — are two new virus-targeting drugs called protease inhibitors, boceprevir (trade name Victrelis) and telaprevir (trade name Incivek).

The drugs, which came out in the summer of 2011, were designed to be taken in conjunction with the standard treatment, which itself is a combination of two drugs, an interferon and an antiviral called ribavirin. While the new triple therapies increase the chances of kicking the virus, they have more severe side effects — such as full body rash and rectal bleeding — and boost costs. Boceprevir adds $1,100 per week to the cost of treatment, and telaprevir adds $4,100 per week.

"At the outset, it was not at all clear to me that drugs as expensive as these, which are added onto the standard therapy, would result in sufficient benefits and reduced costs from averted liver cancers and transplants to make them cost-effective," said Goldhaber-Fiebert, who is also a faculty member of Stanford Health Policy at the university's Freeman Spogli Institute for International Studies.

Goldhaber-Fiebert, Liu and their colleagues wanted to know when or if doctors should prescribe the new treatments. Should doctors prescribe them to all hepatitis C patients? Or, should only patients with advanced disease be treated with the new drugs? With such high costs, the answers could have sweeping impacts on health-care budgets, particularly for public health systems such as the Department of Veterans Affairs hospitals where many hepatitis C patients receive care.

To find the answers, they used their model to compare the pros and cons of three treatment strategies: Giving all hepatitis C patients the standard treatment, giving all of them a triple therapy or giving triple therapy only to those patients less likely — based on their IL-28B gene — to respond to standard therapy. For each strategy, they examined both of the new triple therapies. They also considered patients with mild and advanced disease.

After intense statistical and simulation analysis, the model showed that the new triple therapies were indeed cost-effective for chronic hepatitis C patients with advanced liver disease. Despite the large price tag and side effects, the new treatments help these patients avoid costly cancers and liver transplants — as well as allowing them to live longer, higher-quality lives.

For those patients with mild disease, the model indicated that determining their IL-28B genotype is the best next step, before prescribing a treatment.

The closer the threat of severe disease, the more justified treatment costs and risks become, said Goldhaber-Fiebert. "That would be the bottom line."

Though these new drugs may offer relatively desirable options now, both Goldhaber-Fiebert and Liu noted that additional, and perhaps more effective, drugs are already in clinical trials.

"As more and better treatments become available, the decision will continue to evolve, requiring further analysis," Liu said. "Patients and health systems could also benefit from price competition with multiple treatment options available." But ultimately, she added, treatment decisions will remain a private conversation between a doctor and a patient.

Provided by Stanford University Medical Center (news : web)

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Hepatitis C Now Killing More Americans than HIV

Image courtesy of iStockphoto/sjlocke

By Katherine Harmon | February 20, 2012|

The number of people who die from HIV-related causes each year in the U.S. is now down to about 12,700—from a peak of more than 50,000 in the mid-1990s—thanks to condom education and distribution campaigns, increased testing and improved treatments. But now a different infectious disease is quietly killing even more people than HIV is:

Hepatitis C.

The majority of the 3.2 million people who are estimated to have chronic hepatitis C virus (HCV) in the U.S. are baby boomer adults.

And most of those infected with the virus do not know that they have it, which means they could easily be spreading it to others via exposure to blood—or, occasionally, sexual contact.

Although long-term intravenous drug users are at particular risk, so are “those who experimented with [such] drugs for a limited time in their youth,” Harvey Alter and T. Jake Liang, both of the National Institutes of Health, wrote in an essay published online Monday in Annals of Internal Medicine. “These bygone experiences do not often connote risk to the affected persons nor serve as a reason to seek testing,” they noted, making this slow-developing disease difficult to catch before it develops into cirrhosis or liver cancer (hepatocellular carcinoma). Their essay was part of a four-paper special series on hepatitis C.

More than 15,000 people died from hepatitis C-related issues in the U.S. in 2007—about three quarters of whom were people aged 45 to 64, according to Alter and Liang. And that number is expected to double as the bulk of the population with the disease get older. The cost of treating all of these people is likely to top $6.7 billion in the decade of 2010 to 2019.

Much of that growth is anticipated because those infected with hepatitis C often don’t seek treatment until the disease has caused serious damage, according to another paper published Monday in the same issue of Annals of Internal Medicine. “Hepatitis C virus infection is often asymptomatic or causes nonspecific symptoms (depression, arthralgia and fatigue) for decades,” Kathleen Ly, of the U.S. Centers for Disease Control and Prevention (CDC), and her colleagues wrote in their paper.

The good news for those who do get diagnosed is that new hepatitis C drugs are coming onto the market. But they are not cheap. One new promising one, a protease inhibitor called boceprevir, runs about $1,100 per week, which when added to the double-drug cocktail of interfearon and the antiviral ribavirin, makes for especially expensive treatment. Some researchers have proposed that testing patients for a genotype that has a cure rate of less than 40 percent with previous treatment might help make treatment the more cost effective.

A new analysis in the same issue of Annals of Internal Medicine, led by Shan Liu of the Center for Health Policy at Stanford University, found that giving HCV patients of all genotypes a triple-drug cocktail is, indeed, cost-effective for allowing patients to live longer, healthier lives. And as Alter and Liang pointed out, as opposed to HIV or even hepatitis B, HCV can often be effectively cured after six months to a year of antiviral treatment. “Every effectively treated high-risk individual diminishes the infectious pool and the likelihood of secondary transmission.”

With treatment options expanding, many researchers are turning their attention back to the question of locating patients. “As innovative treatments for hepatitis C follow their now-destined progression, the most burning question will not be whether to treat, but rather how to identify the many chronic HCV carriers who are unaware of their infection and are at risk for cirrhosis, end-stage liver disease, or hepatocellular carcinoma,” Alter and Liang wrote.

Knowing that those born between 1945 and 1964 are at the highest risk for HCV infection could help guide screening, according to another study published in the same issue of the journal, led by David Rein, of the CDC. “Because HCV progresses slowly, the risk for serious complications is increasing among infected Americans as time passes,” he and his colleagues wrote. “Without changes in current case identification and treatment, deaths from HCV are forecasted to increase to 35,000 annually by 2030.”

About the Author: Katherine Harmon is an associate editor for Scientific American covering health, medicine and life sciences. Follow on Twitter @katherineharmon.

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The views expressed are those of the author and are not necessarily those of Scientific American.

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Philippine govt. starts ‘Code Yellow’ Hepatitis B awareness program

The best way to prevent Hepatitis B is by getting vaccinated.

Credits: U.S. Navy photo by Photographer's Mate Airman Apprentice Christopher D. Blachly

February 19, 2012

Robert Herriman

Infectious Disease Examiner

The World Health Organization (WHO) reports that 60 percent of the Philippine’s population has been infected with HBV, while approximately 10 percent have chronic or active hepatitis B and are carriers.

According to Dr. Lemuel Delos Reyes, medical doctor and Hepatitis B Awareness Campaign advocate, “This means that there are already around eight to 10 million hepatitis B carriers in the country who might infect more people.”

To draw awareness on the hepatitis B issue in the Philippines, the Philippine Council for Health Research and Development of the Department of Science and Technology (PCHRD-DOST) conducted a seminar on “Code Yellow, Mission Against Hepatitis” to draw awareness on the dreadful disease.

In a report on the PCHRD-DOST web site Friday, Dr. Gerald Belimac, program manager of the Department of Health’s National AIDS STI Prevention and Control Program said, “Hepatitis B is 100 times more contagious than the AIDS virus. It is also the most common cause of liver infection leading to liver cancer - the principal cause of cancer death in many parts of Africa, Asia and the Pacific Region.”

According to the US CDC, Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.

Although there is no cure for hepatitis B it is a preventable disease. The best way to prevent Hepatitis B is by getting vaccinated.

Dr Delos Reyes said, “Vaccination is the easiest and most logical means of preventing the disease. It is also recognized as the most effective and long term means of preventing hepatitis.”

The PCHRD-DOST conducted the seminar “Code Yellow, Mission Against Hepatitis” Jan 30.

Source

Hope for liver cancer patients

ILLUSTRATION: CHOOPONG EAMORAPHAN

Support group and new drugs lessen the pressure on liver cancer patients

Published: 21/02/2012 at 03:13 AM

Once diagnosed with cancer, what a patient needs is morale support from friends and family to cope with their overwhelming grief, fear and confusion.

``But what they need most is self morale. It's very unfortunate that many of us died because they gave up too early,'' said cancer patient Somsak (not his real name).

After learning that he had advanced liver cancer, Somsak said he broke down, cried and cried.

Somsak knew he had the hepatitis B virus 10 years ago. After that, he noticed he began to experience chronic fatigue and unexplained weight loss. His dark orange-coloured urine also worried him.

In addition, he suffered acute abdominal pain. An ultrasound screening detected an abdominal mass in the upper right area of his body. A CT scan and biopsy later confirmed the diagnosis of liver cancer.

``I was shocked when my doctor told me that the cancer was in advanced stage. And that I might only be able to live six more months.''

Never saying die, Somsak decided to join ``the Advanced Liver Cancer Patient Assistance Programme'' following his doctor's suggestion. The programme gives patients cancer oral medicine support.

``I'm lucky because I have responded relatively well to the medication.'' he said.

After two years of medication, Somsak continues to fight bravely against the deadly disease despite some adverse side effects from the medication.

``It is as good as it gets,'' he said. ``Apart from medication, I believe that positive thinking and good emotional health is equally important to fight cancer. We need to be strong and brave if we want to live longer.''

The liver cancer that Somsak has is called hepatocellular carcinoma (HCC), explained Dr Thiravud Khuhaprema, chairman of the National Cancer Institute Foundation. This form of liver cancer is closely linked to chronic hepatitis B and C. It is the most common type of liver cancer that begins in the cells of the liver itself.

``These patients are often found to have a history of viral hepatitis B or C infection. HCC is one of the main cancers that causes death in Thailand and chronic hepatitis B is found in 80% of these cases,'' said Dr Thiravud. ``The infection can cause continual damage to the liver and develop into cirrhosis and cancer.''

He said the frequency of liver cancer is highest in developing countries and quite rare in developed countries. Each year, it is estimated that there are about 350,000 new cases of liver cancer. And two-thirds of the cases are found in countries in Asia. Mongolia is ranked first and Thailand fifth.

In Thailand, liver cancer is the most common cancer in males. It is the third most frequent cancer in females, but it's the number one cause of death among female patients. The incidence rate and the mortality rate of liver cancer in Thailand are steadily rising.

Assoc Prof Narin Voravud, an expert in medical oncology from Chulalongkorn University Hospital pointed out that the relative high rates of HCC in Thailand is reflected in the high frequency of hepatitis B infection.

``One person in every 12 people suffers from hepatitis B infection in Thailand,'' he said. Meanwhile, the number of people with viral hepatitis C infection has been on the increase.

Heavy drinking is also another important cause of liver cancer in Thailand, he noted. The chance for liver cancer is even higher if the drinkers have snacks that contain alfatoxin, a dangerous mould in foodstuffs commonly found in peanuts, wheat and corns that are stored in a wet or humid environment. It's odourless, colourless and tasteless.

``Most Thai people drink alcohol paired with peanuts. These combined factors may trigger the development of HCC,'' said Dr Narin.

HCC liver cancer often does not show any symptoms in its early stage. Like Somsak, patients with advanced stage may experience fatigue, loss of appetite, weight loss, yellowing of the skin and the eyes, abdominal pain (particularly in the upper right area where the liver is present).

Primary liver cancer that affects just a small part of the liver is often treated with surgery to remove the cancerous tumour and the surrounding liver tissues to preserve the important areas of the liver for normal body function. It is possible for patients to suffer from the recurrence of the disease, however.

``Only 10-20% of HCC can be completely removed using surgery. And the recurrent rate is about 50-60%,'' Dr Narin said.

Another treatment option involves inserting particles into the liver artery to block the flow of blood to the tumour. Liver transplants to replace the diseased liver can cure the disease but a living donor graft and matching of organ donors is not easy to find.

It is unfortunate that patients with HCC often suffer from liver cancer, viral hepatitis B infection and cirrhosis of the liver at the same time, he said.

It is not uncommon that patients with liver cancer die shortly after the diagnosis. If the cancer cannot be completely removed, the decline is rapid. Patients may usually continue to live only three to six months.

``Treating patients with liver cancer can be very challenging as we have to deal with three conditions simultaneously,'' Dr Narin said.

Most chemotherapy drugs are not effective to liver cancer. And chemotherapy has not been shown to help patients live longer, he said. The liver often cannot tolerate radiation which harms healthy liver tissues.

``The good news is that the patients who cannot be treated with surgery can now resort to new liver cancer drugs,'' he said. This new medication tackles the cancerous cells and tumour blood vessels directly.

A liver tumour needs new blood vessels for it to grow. Since this medication blocks the growth of new blood vessels, the growth of the tumour is then stopped. The possible side effects include diarrhoea, skin rash and high blood pressure.

In clinical trials overseas, the drug succeeded in extending the lives of patients who cannot be treated with surgery and injection by 44 % one year when compared to 33% of those who received a placebo, said Dr Narin.

In Thailand, a clinical trial involving 140 Thai patients with advanced liver cancer showed that the patients continued to live up to 14 months.

``An improvement of survival probability of four months in Thai patients means that the drug is effective with Thai patients,'' said Dr Narin.

The bad news is that this new medication is extremely expensive. It costs about 250,000 baht a month for the drugs.

``This is why the patients with advanced liver cancer may consider joining the Advanced Liver Cancer Patient Assistance Programme,'' said Dr Thiravud.

The programme which requires participants to pay for the medicine for the first three months before they are accepted, is a collaboration between the National Cancer Institute Foundation and the country's leading pharmaceutical company. Since its inception in 2009, more than 170 patients have participated in the programme.

``But prevention is better than cure,'' stressed Dr Thiravut. To keep liver cancer at bay, people should be vaccinated for hepatitis B. Meanwhile, patients with viral hepatitis B should also be periodically monitored for HCC.''

---

For more on the Advanced Liver Cancer Patient Assistance Programme, call the National Cancer Institute Foundation at 02 354 7025 ext.1221.

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Low-choline diet linked to liver damage in post-menopausal women

Updated: 2012-02-17 17:07:44 CST

Post-menopausal women who consume few foods containing the essential nutrient choline may benefit from liver panel testing. A new study indicates that these individuals may face a higher risk of liver scarring caused by non-alcoholic fatty liver disease.

Choline is found in dairy foods, eggs, broccoli, chicken, beef and legumes. The problem my be worse in post-menopausal women because low levels of estrogen may interfere with the body's ability to absorb and process dietary choline, the researchers said.

Therefore, even individuals who eat adequate amounts of these foods may be at risk.

For the study, researchers administered dietary surveys to more than 600 individuals of various ages and gender who were enrolled in a study of liver disease. The results showed that low choline intake was most strongly associated with liver scarring in post-menopausal women.

Consuming less of the nutrient did not mean that a woman was more likely to develop liver disease, However, it did predict the degree to which the condition would scar her liver and impair its function.

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New measurement for hepatitis B unveiled

2012/02/19 21:17:21

Taipei, Feb. 19 (CNA) A Taiwanese liver disease research team introduced on Sunday a new measurement that helps to better diagnose hepatitis B infections, which affect roughly 2.5 million people in Taiwan, and gauge whether they are under control.
The REVEAL–HBV Study Group, led by Chen Chien-jen, unveiled the new measurement at an annual meeting of the Asian Pacific Association for the Study of the Liver (APASL) in Taipei.

The new measurement detects the amount of hepatitis B surface antigens (HBsAg) in a person's body. The antigens are proteins produced by the hepatitis B virus (HBV) that peak with the first appearance of clinical disease symptoms.

The new measurement reveals how a hepatitis B carrier's immune system responds to the virus and helps doctors evaluate the effectiveness of certain medications, according to Kao Jia-horng, APASL chief and a professor at National Taiwan University's College of Medicine.

Chen, an academician at Academia Sinica, Taiwan's top research institution, said that the new measurement complements existing gauges measuring the amount of hepatitis B virus DNA and will help doctors more accurately assess the risk of hepatitis B infections developing into liver cirrhosis and liver cancer.

Liaw Yun-fan, another academician at the meeting, said that a growing body of research shows the amount of HBsAg is indrectly related to how hepatitis B infections come under control.

Liaw said the lower the HBsAg level, the more the infection is under control.

Among the other existing measurements for hepatitis B infections are age, sex, and liver function index.

(By Chen Ching-fang and Scully Hsiao)
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Taiwan offers new model to predict hepatitis C cancer risk

2012/02/19 20:14:20

Taipei, Feb. 19 (CNA) A Taiwan-led research team has successfully devised a new prediction model to calculate the likelihood of hepatitis C patients developing liver cancer, the team leader said Sunday.

The model incorporates indicators such as age, the liver function indexes ALT and AST, hepatitis C virus RNA in serum, cirrhosis and the genotype of the virus, said Chen Chien-jen at a session of the Conference of the Asian Pacific Association for the Study of the Liver held in Taipei.

Chen, vice president of Taipei-based Academia Sinica, said the serum data was particularly important in predicting the chances of developing liver cancer.

The model, which can predict a result with 80 percent accuracy, assigns a score on 0-25 scale to analyze each case. The higher the score, the higher the risk of getting liver cancer, Chen said.
Hepatitis B and C viruses are the main causes of liver cancer in Taiwan, Chen said, with 20-25 percent of liver cancer cases triggered by the hepatitis C virus and 70-75 percent by the hepatitis B virus.

Close to 3 million people in Taiwan's 23-million population carry the hepatitis B virus, while some 600,000 carry the hepatitis C virus, according to the Department of Health.

With the model, "we hope to identify those facing higher risk of getting liver cancer and treat them as early as possible," Chen said.
Chen's team also launched a model in 2010 to calculate the chances of the hepatitis B virus developing into liver cancer.

In the future, the prediction models will be available on the Internet and in apps on smartphones to allow individuals to determine their own risk factor, Chen said.

(By Elaine Hou)
ENDITEM/ls

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