October 6, 2012

Treatment with Peg-IFNα2a/ribavirin and low-dose NSAID for patients with chronic hepatitis C and rheumatoid syndrome

Lilea GC,et al. Show all

Lilea GC, Streba CT, Vere CC, Rogoveanu I.


Eur J Gastroenterol Hepatol. 2012 Sep 24. [Epub ahead of print]


Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.


OBJECTIVE: To examine the safety and efficiency of using Peg-IFNα2a/ribavirin and low-dose NSAID therapy in patients with rheumatoid syndrome (RS) and chronic hepatitis C (CHC).

METHODS: A group of 10 patients (group 1) known to have RS and established CHC undergoing Peg-IFNα2a/ribavirin and low-dose NSAID therapy was compared with a control group of 10 patients (group 2) also with CHC and associated RS, with no antiviral treatment. Their charts were reviewed for serological and clinical signs of rheumatic disease evolution while undergoing this type of treatment.

RESULTS: At the end of a follow-up period of 12 months, patients receiving low-dose NSAID and Peg-IFNα2a/ribavirin therapy showed a sustained virusological response and also decreased levels of inflammation serological markers, with an improvement in the clinical rheumatic symptoms. In contrast, patients in group 2 showed no significant clinical modification in their rheumatic status.

CONCLUSION: Peg-IFNα2a/ribavirin and low-dose NSAID in patients with RS and CHC appear to be well tolerated and can be efficient for rheumatic manifestations. Further controlled studies are required to confirm the results.

23011037 [PubMed - as supplied by publisher]

Full text: Lippincott Williams & Wilkins


Combinations of simple baseline variables accurately predict sustained virological response in patients with recurrent hepatitis C after liver transplantation

Crespo G,et al. Show all

Crespo G, Carrión JA, Coto-Llerena M, Mariño Z, Lens S, Pérez-Del-Pulgar S, García-Retortillo M, Miquel R, Bosch J, Navasa M, Forns X.


J Gastroenterol. 2012 Sep 26. [Epub ahead of print]


Liver Unit, Institut de Malalties Digestives, Hospital Clínic, CIBERehd, IDIBAPS, Villarroel 170, 08036, Barcelona, Spain.


BACKGROUND: The efficacy of antiviral therapy in patients with hepatitis C recurrence after liver transplantation (LT) is far from optimal and a careful selection of candidates with the best chances to achieve sustained virological response (SVR) is relevant. Moreover, investigating the effects of sustained viral clearance on clinical outcomes is particularly significant. We aimed to identify and combine the best baseline predictors of SVR and to assess the clinical outcomes of antiviral therapy after LT.

METHODS: We studied 144 hepatitis C virus (HCV)-infected LT recipients who underwent antiviral therapy following transplantation. Baseline predictors of SVR including donor and recipient interleukin IL28B (IL28B) rs12979860 genotype were evaluated, and the long-term effects of antiviral therapy on clinical outcomes were assessed.

RESULTS: The presence of an IL28B CC genotype with either low viral load (VL), young donor age, or cyclosporine A (CsA)-based immunosuppression identified individuals with 69-80 % probabilities of SVR. In contrast, only 20 % of recipients with a CT/TT IL28B genotype and either high VL, old donor age, or non-CsA immunosuppression achieved an SVR (p = 0.004). Regarding clinical outcomes, the 5-year cumulative probability of graft loss was 2 % for the SVR patients and 48 % for non-responders (p < 0.001).

CONCLUSIONS: The use of simple combinations of baseline variables including IL28B polymorphisms identifies HCV-infected LT recipients with different probabilities of response to antiviral treatment. SVR is associated with improved clinical outcomes.

23011083 [PubMed - as supplied by publisher]

Full text: Springer


HCV Treatment in Prison Could Be Key Public Health Measure

Last Updated: October 05, 2012

Incarcerated patients with hepatitis C virus infection are as likely to be treated and to achieve a sustained viral response as non-incarcerated patients, according to research published in the October issue of Hepatology.

FRIDAY, Oct. 5 (HealthDay News) -- Incarcerated patients with hepatitis C virus (HCV) infection are as likely to be treated and to achieve a sustained viral response (SVR) as non-incarcerated patients, according to research published in the October issue of Hepatology.

John P. Rice, M.D., of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a study involving 521 non-incarcerated and 388 incarcerated patients evaluated for HCV treatment at a single academic center from 2002 through 2007.

The researchers found that 61.2 percent of non-incarcerated and 60.3 percent of incarcerated patients underwent treatment with pegylated interferon and ribavirin. Patients who were incarcerated were more likely to be male, black, and have a history of alcohol or intravenous drug use; and those who were treated were less likely to have received previous treatment or to have genotype 1 virus. The prevalence of HIV co-infection was similar between the groups. An SVR was achieved in 42.9 and 38.0 percent of incarcerated and non-incarcerated patients, respectively (P = 0.304). Increased SVR was significantly associated with full treatment course, non-genotype 1 virus, younger age at start of treatment, and negative HIV status. Incarceration status was not a significant predictor of SVR.

"Anti-viral treatment of the HCV-infected incarcerated population is not only effective but can be as successful as HCV treatment in the general population," the authors write. "Given the scale of the prevalence of HCV infection in the incarcerated population, we suggest that anti-viral treatment while in prison is the optimal time for treatment to reverse a public health crisis."

One author disclosed financial ties to the pharmaceutical industry.

Full Text (subscription or payment may be required)


Cleanse your liver in seven days


Onions and garlic help the liver detoxify.

Michele Chevalley Hedge

From: body and soul

October 06, 2012 6:00PM

NUTRITIONIST Michele Chevalley Hedge provides a day-by-day guide to liver cleansing

Spice things up. Turmeric helps protect the liver against toxic damage and can even regenerate damaged liver cells. Turmeric also boosts the production of bile and hepatic dusts, which is beneficial to those with gall bladder issues.

Go green. Green tea has antioxidant properties and is loaded with catechins, a type of antioxidant that helps eliminate fat accumulation and promote proper liver function. It also protects against toxins that can cause serious liver damage.

Befriend onions and garlic. Foods rich in sulphur-containing compounds are one of the primary types of molecules used to help the liver detoxify. Garlic contains allicin and selenium which help protect the liver from toxic overload.

Try grapefruit. This fruit is rich in vitamin C and antioxidants which are excellent for cleansing the liver. One of the flavonoids in grapefruit, naringenin, contains a compound that causes the liver to burn fat rather than store it.

Sidestep alcohol and fructose. Both are very hard on the liver. Fructose is converted into fat that gets stored in your liver and other tissues. When consumed in excess this can lead to non-alcoholic fatty liver disease (NAFLD).

Go nuts for walnuts. All nuts contain amino acids and essential fatty acids, but walnuts in particular are high in the amino acid L-arginine and antioxidant glutathione which can assist in detoxifying the liver and oxygenating
the blood.

Eat. People sometimes think that cleansing the liver is best supported by strict detoxing or fasting, however the simple act of eating whole foods can clean up your liver. We need nutrients to support our body’s natural detoxification.


What Is Cirrhosis?

October 6, 2012

I’ve heard a lot about liver cirrhosis. Can you tell me what it means, what causes it and what types of treatment are available?

— Stan, Hollister

Answered by Dr. Brian Berk, St. Luke’s Clinic, Gastroenterology:

Cirrhosis is a term used to describe advanced scarring of the liver. There are four stages of scarring. In stage 1, you are replacing single cells in the liver with scar. With stage 2, you are replacing several cells in a row with scar. In stage 3, you are creating bands of scarring that replace entire sheets of cells. Finally in stage 4, the bands of scarring interconnect and form nodules of scarring, which trap cells. The condition of cirrhosis interferes with the flow of blood through the liver, which leads to a decrease in normal liver functions and an increase in blood detouring around the liver.

Any chronic liver disease that inflames liver cells can progress into cirrhosis. The most common causes of cirrhosis are excessive long-term use of alcohol viral hepatitis (B and C), and NASH (a type of fatty liver disease). There are also a variety of inherited liver diseases, autoimmune liver diseases, medication-induced liver conditions and other causes.

Many times, you are not aware that you have liver disease until the organ is failing. You can maintain liver function with as little as 10 percent of the total number of functioning liver cells. Subtle symptoms that may indicate liver failure including pain in the upper right side of your abdomen, fatigue, muscle wasting, pain in muscles or joints, headaches, and nausea. The more visible symptoms include jaundice, confusion (dementia-like symptoms), ascites/edema (fluid accumulation in the abdomen and legs), and intestinal bleeding from engorged veins that line the esophagus or stomach. Cirrhosis can also lead to liver cancer that arises in the nodules of scar from chronic liver cell inflammation.

To determine if there is liver disease, blood tests and imaging (ultrasound or CAT scan) are done to determine the scope of the problem. If there is further concern, a liver biopsy can be performed to clarify the type of disease and stage of scarring. This procedure is performed with sedation to minimize discomfort. Once the underlying disease is confirmed, treatment options are available for most chronic liver diseases.

In terms of treatment for cirrhosis, management of the underlying disease can help slow down or reverse the damage. This is most notable with Hepatitis C and NASH. Routine blood testing and imaging are performed to monitor liver functions and watch for liver cancer. Routine endoscopic monitoring of the engorged veins that line the stomach and esophagus allows for the prevention of bleeding with medication and variceal ligation. There are also a variety of treatment options for the other complications of cirrhosis including liver cancer. In some cases, a liver transplantat may be a treatment option.

If you think you may have liver disease, the best course of action is to see your primary care physician and get blood tests that can detect liver disease. Your liver health will be determined by these tests. If liver disease is suspected, you will be referred to a specialist who will determine the cause of liver disease, stage of the condition and treatment options.

Disclaimer: The content of this article is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Do not stop or delay seeking treatment because of something you read in this article. Further, the views or opinions expressed in this article are for informational purposes only and do not necessarily represent those of St. Luke’s. Reliance on any information provided by St. Luke’s, St. Luke’s employees or others supplying information for the column at the invitation of St. Luke’s is solely at your own risk.


Proton pump inhibitors increased infection rate in decompensated cirrhosis patients

Bajaj JS. Aliment Pharmacol Ther. 2012;doi:10.1111/apt.12045.

September 19, 2012

Veterans with decompensated cirrhosis who started proton pump inhibitor therapy after decompensation were more likely than nonusers to develop serious infections in a recent study.

Researchers evaluated data from 1,268 US veterans who began proton pump inhibitor (PPI) use for decompensated cirrhosis between 2001 and 2009, along with 1,268 matched controls who did not use PPI. A parallel analysis was conducted of patients using H2 receptor antagonists (H2RA) (n=199) and matched controls (n=199). Incidence of serious infections requiring hospitalization, including skin, lower respiratory, urinary and kidney infections, along with Clostridium difficile, infectious gastroenteritis, sepsis and bactremia, was recorded.

Serious infections occurred in 25.3% of PPI users, with an incidence rate of 675 per 1,000 person-years. No association was found between PPI use and serious infection incidence rate (crude propensity-matched HR=1.08; 95% CI, 0.90-1.31), but infections related to acid suppression tended to occur more frequently in this group than among nonusers (crude HR=1.22; 95% CI, 0.97-1.52). Potential confounders, including age, race/ethnicity and concomitant medication, were similarly distributed between the two groups, but PPI users were more likely to have five or more comorbidities (41.2% of patients vs. 32.1% of nonusers).

Accounting for time-varying PPI use, serious infections were found to develop more quickly among PPI users than nonusers (adjusted HR=1.66; 95% CI, 1.31-2.12). Serious infections related to acid suppression also developed more quickly among PPI users (adjusted HR=1.75; 95% CI, 1.32-2.34), and comprised a larger number of all infections (75%) than among nonusers (64%).

Among H2RA users, 25.9% experienced serious infections, with 17.7% of patients developing infections related to acid suppression. Adjusted HRs were 1.59 for serious infection (95% CI, 0.80-3.18) and 0.92 for infections related to acid suppression (95% CI, 0.31-2.73) compared with nonusers. Neither result was statistically significant.

“Veterans with decompensated cirrhosis who were started on PPI therapy after decompensation had a significantly higher risk of developing serious infections compared with those who were not initiated on gastric acid suppression,” the researchers concluded. “As patients with decompensated cirrhosis remain at a high risk of serious infections, clinicians should reevaluate the reason for prescribing PPI and, wherever possible, replace their acid suppressive needs with H2RAs.”


Hepatitis C Is an Emerging Infection Among HIV-Infected MSM

During the past 13 years, the incidence of HCV infection among men who have sex with men increased 18-fold in the Swiss HIV Cohort Study.

Hepatitis C virus (HCV) infection is common among HIV-infected individuals, especially injection-drug users (IDUs) and hemophiliacs. However, during the past few years, HIV-infected men who have sex with men (MSM) have also been identified as a high-risk group for HCV infection (JW AIDS Clin Care Aug 8 2011). To assess changes in the incidence of HCV infection among these various risk groups, investigators looked at 13 years' worth of data (1998–2011) from the Swiss HIV Cohort Study. Study participants were screened for HCV infection at entry into the cohort and every 2 years thereafter.

At study enrollment, 3% of MSM, 92% of IDUs, and 11% of heterosexuals were already HCV positive. Of the 8709 study participants who were HCV negative at baseline, 6534 had follow-up HCV serology results and were included in this analysis; 51% were MSM, 2% IDUs, and 47% heterosexuals. During follow-up, 3% of MSM, 33% of IDUs, and 0.8% of heterosexuals experienced an HCV seroconversion. The incidence rate among MSM increased from 0.2 per 100 person-years in 1998 to 4.1 per 100 person-years in 2011, an 18-fold increase. In contrast, the incidence rate among IDUs decreased, from 13.9 to 2.2 per 100 person-years. Among MSM, inconsistent condom use and a past history of syphilis were significantly associated with HCV seroconversion.

Comment: HIV-infected MSM are at high risk for HCV coinfection and should be screened at entry into care. Those who are HCV negative should undergo liver function testing every 6 months and HCV antibody testing every year, as recommended by the European AIDS Treatment Network (JW AIDS Clin Care Feb 28 2011 and May 25 2012). Prompt recognition of HCV infection may allow patients to be treated during acute HCV infection, when response to therapy may be greater.

Carlos del Rio, MD

Published in Journal Watch HIV/AIDS Clinical Care September 24, 2012


Wandeler G et al. Hepatitis C virus infections in the Swiss HIV Cohort Study: A rapidly evolving epidemic. Clin Infect Dis 2012 Sep 12; [e-pub ahead of print]. (http://dx.doi.org/10.1093/cid/cis694)


Retinopathy Is Common with Interferon Therapy for HCV Infection

Ophthalmologic screening is warranted in patients with hypertension.

Interferon-based therapy is currently the standard treatment for hepatitis C virus (HCV) infection and likely will be for the near future. Retinopathy has been associated with interferon therapy, but few studies have described its frequency or clinical significance.

In this prospective, longitudinal study, the occurrence of retinopathy was evaluated in 97 consecutive patients at a single center who received treatment for HCV infection with interferon and ribavirin for 48 weeks. All patients underwent extensive ophthalmologic examinations at baseline, 3 months, 6 months, and 3 months posttreatment. Retinopathy was defined as the presence of cotton wool spots, retinal hemorrhages, or microaneurysms.

During therapy, retinopathy occurred in 31% of patients, including nine (9.3%) with retinopathy at baseline. In univariate analysis, age, hypertension, preexisting intraocular lesions, metabolic syndrome, and cryoglobulinemia were associated with retinopathy. In multivariate analysis, only hypertension remained a significant risk factor (hazard ratio, 4.99; 95% confidence interval, 2.29–10.89). The frequency of retinopathy increased with successive ophthalmologic examinations and was consistently higher for patients with hypertension than for others, peaking at 68% and 19% respectively at the 6-month exam. Thirty percent of patients complained of visual disturbances. One patient (1.1% of the cohort) had persistent long-term vision loss and was discontinued from therapy at 6 months. This patient had baseline preexisting retinopathy.

Comment: This prospective study is one of the few to specifically address the issue of interferon-induced retinopathy. Approximately one third of patients developed or experienced worsening of baseline retinopathy during therapy. Moreover, patients with hypertension had a fivefold higher incidence of retinopathy than those without hypertension. Permanent visual problems developed in only one patient, who was hypertensive with baseline retinopathy. These findings support ophthalmologic examinations in patients with HCV infection and hypertension who are about to undergo interferon-based therapy.

Atif Zaman, MD, MPH

Published in Journal Watch Gastroenterology September 14, 2012


Vujosevic S et al. Pegylated interferon-associated retinopathy is frequent in hepatitis C virus patients with hypertension and justifies ophthalmologic screening. Hepatology 2012 Aug; 56:455.

Medline abstract (Free)


OraQuick® In-home HIV Test- How-to Video

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Also See: Home Test for H.I.V. As a Screen of Partners