March 4, 2012

QUAL research - stage 4 liver cancer

Find A Cure Panel is looking for people with Stage IV liver cancer or the caregivers of people with Stage IV liver cancer to participate in anonymous and qualitative research that will take an estimated 60 minutes of your time.

This is opinion based, experiential research and is NOT a drug trial.
Note that Stage IV is also known as “advance disease” or metastatic liver cancer.

If you participate, FACP will donate $100 to a non-profit of your choice.

If you are interested in participating, please email FACP at:

Boosting cell production could help treat liver disease

Public release date: 4-Mar-2012

Contact: Catriona Kelly
University of Edinburgh

Scientists have shed light on how the liver repairs itself with research that could help develop drugs to treat liver disease

Scientists have shed light on how the liver repairs itself with research that could help develop drugs to treat liver disease.

Researchers at the Medical Research Council (MRC) Centre for Regenerative Medicine at the University of Edinburgh have discovered how to enhance the production of key cells needed to repair damaged liver tissue.

The study, published in the journal Nature Medicine, could help heal livers affected by diseases such as cirrhosis or chronic hepatitis.

Scientists were able to unpick the process of how different cells in the liver are formed.

When the liver is damaged it produces too many bile duct cells and not enough cells called hepatocytes, which the liver needs to repair damaged tissue.

They found they could increase the number of hepatocyte cells – which detoxify the liver – by encouraging these cells to be produced instead of bile duct cells.

Understanding how liver cells are formed could help to develop drugs to encourage the production of hepatocytes to repair liver tissue. This could eventually ease the pressure on waiting lists for liver transplants.

Professor Stuart Forbes, Associate Director at the MRC Centre for Regenerative Medicine at the University of Edinburgh, who is a consultant hepatologist and was the academic leader of the study, said: "Liver disease is on the increase in the UK and is one of the top five killers. Increasing numbers of patients are in need of liver transplants, but the supply of donated organs is not keeping pace with the demand. If we can find ways to encourage the liver to heal itself then we could ease the pressure on waiting lists for liver transplants."

Liver disease is the fifth biggest killer in the UK. There are almost 500 people waiting for a liver transplant, compared to just over 300 five years ago.

The production of hepatocyte cells was increased by altering the expression of certain genes in early stage liver cells.

Dr Luke Boulter, of the University of Edinburgh's MRC Centre for Regenerative Medicine and first author on the paper, said: "This research helps us know how to increase numbers of cells that are needed for healthy liver function and could pave the way for finding drugs that help liver repair. Understanding the process in which cells in the liver are formed is key in looking at ways to repair damaged liver tissue."

Dr Rob Buckle, Head of Regenerative Medicine at the MRC, said: "Liver transplants have saved countless lives over the years, but demand will inevitably outstrip supply and in the long term we need to look beyond replacing damaged tissues to exploiting the regenerative potential of the human body. The MRC continues to invest heavily across the breadth of approaches that might deliver the promise of regenerative medicine, and this study opens up the possibility of applying our increasing knowledge of stem cell biology to stimulate the body's own dormant repair processes as a basis for future therapy."


The study was carried out in collaboration with the University's MRC Centre for Inflammation Research, the Beatson Institute for Cancer Research in Glasgow and the K.U. Leuven in Belgium.


HIV Rate Among U.S. Injection Drug Users Falls: CDC

From Reuters Health Information

By Julie Steenhuysen

CHICAGO (Reuters) Mar 01 - HIV infections among injection drug users in the United States have fallen by half in the past decade, but HIV testing is also down and risky behaviors such as needle-sharing persist, raising worries that progress may be short-lived, U.S. health experts said on Thursday.

A study by researchers at the U.S. Centers for Disease Control and Prevention based on a 2009 survey of 10,000 people from 20 urban areas found that 9% of IV drug users were infected with HIV.

That compared with a rate of 18% in the 1990s.

"Despite the fact that we've seen declines in new HIV infections, a substantial number of IDUs (injection drug users) in major US cities are HIV-infected and their risk behavior remains fairly high," said Dr. Cyprian Wejnert, an epidemiologist at the CDC whose study appeared online today in the CDC's Morbidity and Mortality Weekly Report.

"We found 9% of IDUs were HIV-positive and nearly half of those were unaware of their infection," Dr. Wejnert said in a telephone interview.

HIV rates have been falling in the United States, but pockets of infection continue to persist, especially in high-risk groups such as young people and men who have sex with men.

The latest survey tested individuals for HIV and asked questions about their risk behaviors and use of HIV prevention services.

About one third of injection drug users said they shared syringes, most said they had unprotected sex in the past year and more than half said they had more than one sexual partner.

The study also found that rates of HIV testing in this at-risk population are falling.

"While CDC recommends that individuals are tested for HIV at least annually, only 49%, less than half of those interviewed, reported being tested in the last 12 months," Dr. Wejnert said.

That represents a significant drop from a survey done in 2005-2006, he said.

Dr. Amy Lansky, deputy director in the Division of HIV/AIDS Prevention at CDC, said the findings will be used as CDC focuses its prevention efforts on high risk populations.

"It's a really important part of understanding the leading edge of the epidemic," she said.

"What the data from this report shows is we really do need to continue our efforts to expand HIV testing and improve testing," she said, adding that the CDC also needs to focus its prevention efforts on reaching more drug users. Such efforts include offering new sterile syringes, condoms, and substance abuse treatment.

According to the CDC, 1.2 million Americans have HIV, and 1 in 5 U.S. adults with HIV do not know they are infected.


MMWR 2012.


Ultrasound Dx of HCV Effective in Liver Transplant


By Michael Smith, North American Correspondent, MedPage Today

Published: March 04, 2012

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

Action Points

  • A non-invasive diagnostic method, ultrasound-based transient elastography, can accurately pick up fibrosis and cirrhosis in patients with recurrent hepatitis C after a liver transplant.
  • Note that the major limitation of the technique lies in interpreting results that correspond to intermediate stages of fibrosis.

A non-invasive diagnostic method can accurately pick up fibrosis and cirrhosis in patients with recurrent hepatitis C after a liver transplant, researchers reported.

In a meta-analysis, ultrasound-based transient elastography had excellent diagnostic accuracy in detecting cirrhosis, according to Jayant Talwalkar, MD, and colleagues at the Mayo Clinic in Rochester, Minn.

The major limitation of the technique lies in interpreting results that correspond to intermediate stages of fibrosis, Talwalkar and colleagues reported in the March issue of Liver Transplantation.

"Further studies that confirm our results could highlight the importance of [transient elastography] as a diagnostic tool for liver transplant recipients" with recurrent hepatitis C, Talwalkar said in a statement.

Hepatitis recurrence is common among transplant patients and is "universal" among those who are positive for hepatitis C RNA at the time of transplant, the researchers noted.

And the development of fibrosis is faster in the transplanted organ than in the native liver, resulting in rapid cirrhosis and graft failure. The "only practical approach for improving ... clinical outcomes" is early recognition of patients with progressive recurrent disease, Talwalkar and colleagues argued.

The gold standard for diagnosing fibrosis and cirrhosis is the liver biopsy, they noted, since the degree of inflammation and the stage of fibrosis can be directly measured.

And the stage of fibrosis is needed for the timing of antiviral therapy if patients are eligible, they added.

But there is evidence that liver biopsies -- as well as having the risk associated with an invasive procedure -- may actually understage fibrosis up to 30% of the time, Talwalkar and colleagues said.

To see how well transient elastography performs, they conducted a systematic literature review that turned up six high-quality studies of the issue, five with data on fibrosis and five with data on cirrhosis.

The studies included 470 patients, with a range from 50 to 124. Diagnostic cut-offs for significant fibrosis ranged from 7.1 to 10.1 kilopascals; the values for cirrhosis ranged from 10.5 to 26.5.

Analysis showed that transient elastography had a sensitivity and specificity of 83%, respectively, for detecting fibrosis. The diagnostic odds ratio was 30.5.

For cirrhosis, the sensitivity was 98% and specificity was 84%. The diagnostic odds ratio was 130.

The analysis "yielded excellent summary estimates of the sensitivity and specificity for detecting cirrhosis and good estimates for detecting significant fibrosis," the researchers concluded.

They cautioned that, for both patient subgroups, the results demonstrated varying degrees of statistical heterogeneity, probably owing to such things as differences in study design and "subtle variations in the technical performances" of the two diagnostic methods between studies.

The researchers did not report external support for the study or any potential conflicts.

Primary source: Liver Transplantation
Source reference:
Adebajo CO, et al "Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: a systematic review and meta-analysis" Liver Transpl 2012; 18: 323-331.


HIV Main Focus of Retrovirus Conference

By Michael Smith, North American Correspondent, MedPage Today

Published: March 02, 2012

SEATTLE -- HIV is usually the main focus -- as the name suggests -- of the Conference on Retroviruses and Opportunistic Infections.

And this year will be no exception, according to Scott Hammer, MD, of Columbia University in New York City, co-chair of the scientific program committee.

"Other retroviruses come into play," he told MedPage Today, "but the bulk of the meeting is HIV and its related complications, both opportunistic and non-opportunistic."

But if the overall focus is not much changed, this year's meeting will narrow its gaze to three main areas, Hammer said:

  • Preventing HIV infection, a topic that has included both good news and bad in the past year
  • Treating the major co-infections, tuberculosis and hepatitis C
  • Examining the potential for curing the infection

That last is "not fantasy, it's good science," Hammer said, although for years researchers and clinicians thought the best they could do was make HIV a chronic disease.

Now, though, many leading scientists think it may soon be possible to reach into the reservoirs where HIV hides in the body and eradicate the virus, although exactly how remains a matter of active investigation.

It's unlikely that this meeting will see any reports of a breakthrough in the area – "there aren't going to be any show-stoppers," as Hammer puts it – but he's expecting some incremental progress.

On the other hand, meeting-goers are likely to get more information on using anti-retroviral drugs to prevent HIV infection in the first place, Hammer said.

That field has been spurred by results from several trials, showing that treating people at risk of infection and also treating partners of infected people reduces the risk of infection.

But other trials – some looking at using anti-retroviral drugs in vaginal gels, for instance – have reported disappointing results, so that the overall picture remains unclear, Hammer noted.

"There's a lot of excitement, but also a lot of discussion points," he said.

For instance, the annual N'Galy-Mann lecture, which recognizes important epidemiological or clinical research, will be given this year by the husband-and-wife team of Quarraisha Abdool Karim, PhD, of the Centre for the AIDS Program of Research in South Africa (CAPRISA) and Salim Abdool Karim, MBChB, PhD, of the University of KwaZulu-Natal in Durban, South Africa.

The pair were investigators on the CAPRISA 004 trial, which showed for the first time that a microbicide gel could reduce the risk of infection for women.

Hammer also said he expects to learn more about the prospects for a vaccine, as researchers report on the so-called correlates of risk associated with protection during the RV-144 vaccine trial conducted in Thailand.

That trial, again for the first time, showed a small but significant benefit for a vaccine candidate and researchers want to know why, in the hope that they can tweak some factors and get a better result.

Hammer said he also expects to get some data on new agents and new combinations of agents that are in the clinical trials process, including the so-called quad pill and the integrase inhibitor dolutegravir.

The other major theme will be ways of dealing with some of the major diseases that march in step with HIV – tuberculosis (TB) and hepatitis C.

Hammer said he's looking forward to hearing more about new direct-acting agents against hepatitis C, which present their own challenges when they are used in people with an HIV co-infection.

But the novel agents – two of which have already been approved – have the potential to increase hepatitis cure rates, while reducing the toxicity that complicates therapy and the time it takes to treat the virus.

TB remains a major challenge, especially in resource-poor regions where appropriate treatment of people with co-infection is often difficult to obtain. Meeting attendees will hear about community-based approaches to treatment in Africa.