Beta-blockers reduced bacterial translocation, improved intestinal permeability in cirrhotic patients

May 1, 2013

Patients with cirrhosis treated with beta-blockers experienced improved intestinal permeability and reduced bacterial translocation, reducing the risk for variceal bleeding, in a study presented at The International Liver Congress in Amsterdam.

In a study of 50 patients with cirrhosis, participants’ portal pressure, gastroduodenal and intestinal permeability and LPS-binding protein (LBP) and interleukin-6 (IL-6) levels were measured before and after treatment with nonselective beta-blockers (NSBB). Rates of bleeding and mortality were determined during follow-up.

Severe portal hypertension, defined as hepatic venous pressure gradient (HPVG) of 20 mmHg or greater, was observed in 35 cases. These patients had significantly higher urine sucrose levels (P=.049), sucrose/mannitol ratios (P=.007) and intestinal permeability indices (P=.002), as well as increased LBP (P=.002) and IL-6 levels (P=.025) compared with those with an HPVG less than 20 mmHg. Patients treated with NSBB experienced significant reductions to HVPG, LBP (–16%; P=.018) and IL-6 (–41%; P<.0001).

Those with abnormal gastroduodenal or intestinal permeability, as indicated by sucrose-lactulose-mannitol test results, trended toward increased incidence of variceal bleeding (P=.066 for gastroduodenal and P=.084 for intestinal permeability), as did those with elevated LBP (P=.18) and/or IL-6 (P=.038). Despite the increased incidence rate, none of these conditions was associated with increased mortality (P=.87 for gastroduodenal and P=.994 for intestinal permeability, P=.571 for elevated LBP and P=.594 for elevated IL-6).

“Beta-blockers have been successfully used … as a standard treatment to control blood pressure in other disease areas,” Mauro Bernardi, MD, treasurer of the EASL, said in a press release. “In cirrhosis, they have been used for decades for primary and secondary prophylaxis of bleeding from esophageal varices. The results of this study show that besides improving portal hypertension … their beneficial effects are also due to their ability to reduce bacterial translocation, which may widen the indication for the use of these drugs in this setting.”

For more information:

Reiberger T. #84: Improvement of Intestinal Permeability and Reducing Bacterial Translocation by Betablocker Treatment is Associated with a Lower Risk of Variceal Bleeding. Presented at: the International Liver Congress 2013; April 24-28, Amsterdam.

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Probiotics Cut Risk for Hepatic Encephalopathy in Half

Daniel M. Keller, PhD

May 01, 2013

AMSTERDAM, the Netherlands — Probiotics were effective in helping to prevent a first episode of overt hepatic encephalopathy in patients with cirrhosis, compared with patients not receiving probiotics, according to a new study.

"The patients in the control group had 2 times the chance of developing overt hepatic encephalopathy in the follow-up period," lead author Manish Lunia, MD, from the G.B. Pant Hospital in New Delhi, India, told delegates here at the International Liver Congress 2013.

It is estimated that hepatic encephalopathy occurs in 30% to 45% of patients with cirrhosis, and the mortality rate is 20% to 30%. Because bacterial overgrowth in the small intestine leads to endotoxemia, the researchers reasoned that probiotics could prevent the condition.

For their open-label, prospective, randomized trial, they enrolled patients 18 to 80 years of age with cirrhosis and no history of overt hepatic encephalopathy. A battery of psychometric tests, the critical flicker frequency test, and the psychometric hepatic encephalopathy score were used to diagnose encephalopathy. Glucose hydrogen breath tests were used to identify small intestinal bacterial overgrowth and lactulose hydrogen breath tests were used to identify orocecal transit time.

Study participants were randomly assigned to the probiotic group (n = 86) or the control group (n = 74). The researchers used the commercially available VSL#3, which is a mixture of nonurease-producing organisms: Streptococcus thermophilus and various species of Bifidobacterium and Lactobacillus (110 billion colony-forming units, 3 times daily).

There were no significant differences between the probiotic and control groups in terms of baseline age (about 44 to 47 years), sex, cause of cirrhosis, proportion of Child–Turcotte–Pugh classes, and model for end-stage liver disease (MELD) score. The groups also did not differ in various baseline laboratory parameters, such as small intestinal bacterial overgrowth (38.4% vs 35.1%) and the proportion of patients with minimal hepatic encephalopathy, defined as a psychometric hepatic encephalopathy score of 5 or lower (48.8% and 44.6%).

Patients were followed monthly for signs of overt hepatic encephalopathy or death (mean follow-up time, 38 to 40 weeks). Every 3 months, they underwent psychometric, arterial ammonia level, critical flicker frequency, glucose hydrogen, and lactulose hydrogen breath tests. Six probiotic patients and 5 control subjects were lost to follow-up.

More patients in the probiotic group than in the control group developed overt hepatic encephalopathy (8.8% vs 20.3%). Kaplan–Meier analysis revealed a hazard ratio for developing overt hepatic encephalopathy of 2.1 (95% confidence interval, 1.31 - 6.53; P < .05). There were fewer deaths in the probiotic group than in the control group (7.5% vs 11.5%).

A significantly greater proportion of patients with Child class B and C cirrhosis than with class A cirrhosis developed overt hepatic encephalopathy, but patients with Child class A and Child class B did not differ from each other (P = .36).

Table. Child Class Effect on Development of Hepatic Encephalopathy

Child Class of Cirrhosis	Proportion, %	P value (vs class A)
A	8.3	—
B	13.0	<.05
C	16.5	<.01

In the probiotic group, there were significant improvements from baseline to 3 months in arterial ammonia (P = .04), small intestinal bacterial overgrowth (P = .006), orocecal transit time (P = .05), psychometric hepatic encephalopathy score (P = .01), critical flicker frequency test (P = .02), and minimal hepatic encephalopathy (P = .001). In the control group, there were no significant differences from baseline in any of these parameters.

Factors significantly associated with the development of overt hepatic encephalopathy were minimal hepatic encephalopathy (adjust odds ratio [aOR], 3.1), Child–Turcotte–Pugh score (aOR, 1.6), small intestinal bacterial overgrowth (aOR, 2.1), and critical flicker frequency (aOR, 1.44).

Dr. Lunia reported that 5 patients with minimal hepatic encephalopathy or 31 patients without minimal hepatic encephalopathy would need to be treated to prevent 1 case of overt hepatic encephalopathy.

This study involved patients with a low level of hepatic encephalopathy at worst, and was therefore for prevention, not treatment, session moderator Isabelle Colle, MD, from Gent University in Belgium, who was not involved with the study, told Medscape Medical News. She explained that the use of probiotics is "certainly not" standard for such patients at this point.

She also questioned whether the use of probiotics in these patients is completely benign. "The gut permeability...is increased, so you can imagine that these bacteria can go through the intestine and cause bacterial translocation.... Do you see infections with this treatment?" she asked. It was a short study, and Dr. Lunia did not present any data on infections, Dr. Colle pointed out.

Dr. Lunia and Dr. Colle have disclosed no relevant financial relationships.

International Liver Congress 2013: 48th Annual Meeting of the European Association for the Study of the Liver (EASL). Abstract 78. Presented April 26, 2013.

Source

Combination Drugs are the Future of the European Hepatitis B and C Therapeutics Markets, Says Frost & Sullivan

Benefits include improved drug efficiency, reduced pill burden, and lower dosage frequency

LONDON, May 1, 2013 /PRNewswire/ -- The limited efficacy and negative side-effects associated with current therapeutics for Hepatitis B and C are highlighting the urgent need for new, improved alternatives. Combination therapies offering better clinical outcomes are coming to the fore and look set to transform the European market for Hepatitis B and C.

New analysis from Frost & Sullivan (http://www.lifesciences.frost.com), Analysis of European Hepatitis B and C Therapeutics Markets, finds that the Hepatitis B market earned revenues of $1.26 billion in 2012 and estimates this to reach $1.89 billion in 2019, while the Hepatitis C market is projected to expand from $2.40 billion to $3.66 billion over the same time period. The therapeutic segments covered include interferons and nucleoside analogues for Hepatitis B, and Standard of Care (Peginterferon alfa and Ribavirin) and protease inhibitors for Hepatitis C.

The side-effects associated with interferon-based therapeutics – such as fever, headache, fatigue, muscle and joint pain, shivering, and the ineffective response to Hepatitis C Virus (HCV) genotype 1 patients – are motivating the development of combination therapies.

"Improved drug efficiency, reduced pill burden and lower dosage frequency are among the common advantages related to the use of combination drugs," notes Frost & Sullivan Healthcare Research Analyst Deepika Pramod Chopda . "For instance, the combined use of interferon and interferon-free treatments is expected to yield positive results among infected patients; ribavirin-long acting interferons combination is estimated to boost the therapeutic success rate by over 50-60%."

The market is responding swiftly to the demand for improved therapeutic offerings. There has been an increase in new classes of compounds such as protease inhibitors, NS5a inhibitors, and nucleotide polymerase inhibitors for interferon-free treatment of HCV and Hepatitis B Virus (HBV).

At the same time, wider access to personalised medical treatment is encouraging the uptake of novel, improved therapeutics. The availability of drugs that target viral hepatitis infections according to distinct genetic strains is promoting market development.

HBV and HCV are prevalent among illegal drug users and migrant populations across Europe. However, low awareness means that many affected patients remain untreated.

"Wider access to national counselling programmes and enhancing awareness among high-risk populations such as drug users, infected mothers, and migrants is critical," concludes Chopda. "Such initiatives, together with free screening and reduced treatment costs, will help limit the incidence and impact of Hepatitis B and C."

If you are interested in more information on this research, please send an email to Anna Zanchi , Corporate Communications, at anna.zanchi@frost.com

Analysis of the European Hepatitis B and C Therapeutics Market is part of the Life Sciences Growth Partnership Service programme. Frost & Sullivan's related research services include: European HIV Drugs Market, European Hepatitis B and C Diagnostics Market, U.S. Hepatitis C Market, and U.S HIV/AIDS Therapies Market. All research included in subscriptions provide detailed market opportunities and industry trends that have been evaluated following extensive interviews with market participants.

About Frost & Sullivan
Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today's market participants.

Our "Growth Partnership" supports clients by addressing these opportunities and incorporating two key elements driving visionary innovation: The Integrated Value Proposition and The Partnership Infrastructure.

• The Integrated Value Proposition provides support to our clients throughout all phases of their journey to visionary innovation including: research, analysis, strategy, vision, innovation and implementation.
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For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community. Is your organisation prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies?

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Addition of simeprevir to peginterferon/ribavirin improves SVR rate among HCV patients

May 1, 2013

Simeprevir improves rates of sustained virologic response and may allow for a 24-week treatment duration when added to interferon-based therapy for chronic hepatitis C, according to data presented at the International Liver Congress in Amsterdam.

In the double blind, phase 3 QUEST-1 study, researchers randomly assigned 394 treatment-naive patients with HCV genotype 1 to either 150 mg oral HCV NS3/4A protease inhibitor simeprevir or placebo, for 12 weeks, plus 48 weeks of pegylated interferon alfa-2a with ribavirin (PR). Patients with HCV RNA below 25 IU/mL after 4 weeks of treatment and undetectable RNA at 12 weeks stopped treatment at 24 weeks. All placebo recipients received 48 weeks of PR therapy.

Rapid virologic response occurred in 80% of simeprevir recipients and 12% of the placebo group. Sustained virologic response at 12 weeks after treatment was achieved by 80% of the simeprevir group and 50% of placebo recipients (P<.001). Most simeprevir recipients (85%) stopped treatment at 24 weeks. Patients treated with simeprevir experienced less on-treatment failure (9% vs. 34% of cases) and less relapse (9% vs. 21%).

Similar results were observed in the QUEST-2 study, in which researchers randomly assigned 391 treatment-naive patients to simeprevir or placebo in addition to therapy with peginterferon alfa-2a or alfa-2b with ribavirin. In this trial, RVR occurred in 79% of simeprevir recipients and 13% of the placebo group, and SVR at 12 weeks occurred in 81% of the simeprevir group and 50% of placebo recipients (P<.001). Most patients in the simeprevir group (91%) were able to stop therapy after 24 weeks. Rates of on-treatment failure (7% vs. 32%) and relapse (13% vs. 24%) also were lower among simeprevir recipients.

In QUEST-1, commonly reported adverse events included headache, fatigue and pruritus, with 3% of simeprevir recipients discontinuing treatment due to adverse events. Common events in the QUEST-2 trial included headache, fatigue, pruritus and flu-like illness, with similar incidence rates of adverse events regardless of the type of peginterferon administered.

“Simeprevir 150 mg QD was well tolerated, leading to a high SVR 12 rate … when administered with either [peginterferon alfa-2a or -2b],” the researchers wrote. “The majority of patients receiving simeprevir [were] able to shorten therapy to 24 weeks.”

For more information:

Jacobson I. #1425: Simeprevir (TMC435) With Peginterferon/Ribavirin for Chronic HCV Genotype-1 Infection in Treatment-Naive Patients: Results from QUEST-1, a Phase III Trial. Presented at: The International Liver Congress 2013; April 24-28, Amsterdam.

Manns M. #1413: Simeprevir (TMC435) With Peginterferon/Ribavirin for Treatment of Chronic HCV Genotype-1 Infection in Treatment-Naive Patients: Results from QUEST-2, a Phase III Trial. Presented at: The International Liver Congress 2013; April 24-28, Amsterdam.

Source

Alicia Keys launching HIV campaign aimed at women

By Saundra Young, CNN

updated 12:03 PM EDT, Wed May 1, 2013

"We can't act like it's not happening," Alicia Keys says of HIV. "We have to make sure we know that we're all at risk."

(CNN) -- You know her best as a multi-platinum recording artist and a 14-time Grammy award-winning singer, songwriter and producer.

But Alicia Keys has also made quite a name for herself as a philanthropist and AIDS advocate.

It was in 2003, on her first trip to Africa, when Keys witnessed firsthand the disease's devastation.

When she returned to the United States, she co-founded "Keep a Child Alive," an organization that has raised millions to care for HIV/AIDS patients in Africa and India.

"So, as I've grown, you know, I think one of the things that I've realized is that there are not the headlines about the AIDS pandemic here in America that there should be, and it is shocking, and it is unacceptable," Keys told CNN last month.

CDC: Half of young people with HIV don't know it

"Yet we're not speaking about it, and so that's what's kind of brought me around to really becoming a part of what I like to say, 'bridging the conversation' so that there's not only an international conversation, there's not only a domestic conversation, there's a global conversation that we can all be a part of."

Keys brought that conversation to Washington, where she met with women being treated at the United Medical Center's Infectious Diseases Clinic. She also teamed up with Greater Than AIDS, a national public information group founded by the Kaiser Family Foundation and the Black AIDS Institute, to launch her latest initiative -- a campaign aimed at reaching out specifically to American women.

It's called "Empowered" and phase one features a video of Keys and five women who are HIV-positive from all walks of life.

They include Stephanie, a college graduate diagnosed at 19; and Kym, diagnosed three years ago after her new husband got sick and died of the disease (she did not know he'd been HIV-positive for a decade).

Also included are Cristina, a graduate student born with the virus; Jen, a wife and mother who was diagnosed at 18; and Eva, a wife, mother, grandmother and home health care professional who found out she was HIV-positive when she was just 17 -- and pregnant.

The women share their stories and their determination to change the course -- and the face -- of HIV/AIDS.

Keys said she wants all women to know the facts about HIV and its impact on women; to be able to speak openly about the disease with family and friends; to protect themselves and their loved ones; to get tested without shame; and to live rich, healthy lives by getting and staying on treatment.

Why youths aren't getting tested for HIV

"We can't act like it's not happening. We have to make sure we know that we're all at risk. This is all of our issues, you know. This doesn't make you bad. ... You shouldn't feel like you're ashamed. We have to make sure that we are demanding access to being tested. We have to demand access to treatment with dignity."

She found an ally in senior White House adviser Valerie Jarrett, whose passion about the epidemic inspired her. Part of that passion, Jarrett said, comes from losing her sister-in-law nearly 20 years ago to the disease.

"She was married with a young child and didn't really get the testing that she should have had early on in her illness because it never occurred to anyone that a married mom would actually ... be HIV positive," Jarrett told CNN.

"Losing her was just devastating for our family and so that's where I began to realize, of course, this could happen to anybody's family."

More than 1.1 million Americans are HIV positive, according to the Centers for Disease Control and Prevention. One in five don't know they're infected. One in four people living with HIV is a woman.

In Washington, one of the hardest-hit areas in the country, rates among African-American women have skyrocketed -- more than 92% of women living with HIV there are black. It was here, last year, that Keys and Jarrett came together and decided to support each other's efforts.

President Barack Obama is committed to the goal of an AIDS-free generation and will do everything in his power to eradicate the disease, according to Jarrett. That includes $23 billion for HIV in next year's proposed budget. But, said Jarrett, HIV still has to be brought out of the shadows.

Timeline: AIDS moments to remember

"We can't pretend it doesn't exist," Jarrett said. "When people share these stories, it de-stigmatizes it, it brings it out in to the light and when we do that, we improve the quality of life that all people will have."

For its part, Empowered will provide community-based grants of up to $25,000 for programs focused on women. That, Keys hopes, will help open up a meaningful dialogue in this country.

"For a woman and a black woman, you know, this is a conversation that we must have as all women. Again, as all human beings, we have to have this conversation," she said.

"I feel like this is an incredibly wonderful opportunity that we have to have a real dialogue, woman to woman, mother to mother, sister to sister, brother to sister ... father to daughter, daughter to mother, you know, friend to friend. This is what we have to start absolutely being open about."

Source

Targeted drugs to tackle hepatitis C

But experts debate US screening recommendations.

Beth Mole

01 May 2013

John strains to recall the gap between learning that he had hepatitis C and deciding to get treated: it was either four years or five. His thinking is clouded by the combination of three drugs that he is taking to clear the infection. After the treatments’ other side effects set in — severe flu-like symptoms, depression and exhaustion — he took leave from his job as a chef in New York. John, whose name has been changed to protect his privacy, was at high risk of catching the virus, having once been addicted to crystal methamphetamine. But as a 51-year-old, he is also a baby boomer — a member of the generation born between 1945 and 1965 — millions of whom will face the disease and its sometimes harrowing treatment.

Better drugs are on the way. But the possibility of improved treatment is intensifying a debate about whether to screen a broad swathe of the US population for hepatitis C.

Last month, the pharmaceutical company Gilead, based in Foster City, California, submitted its hepatitis-C drug sofosbuvir to the US Food and Drug Administration for approval, after phase II trials showed a 100% success rate in a few patient groups when it was used in combination with existing drugs. Last week, the first phase III results showed similarly promising results (E. Lawitz et al. N. Engl. J. Med. http://doi.org/mcc; 2013).

The drug is one of at least ten in phase III trials in the United States that promise to improve results or reduce side effects. The first of these drugs could reach the market as early as 2014, and a recommendation from the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, to screen an entire generation for the disease could create vast demand for them.

John is a part of a demographic time bomb. Up to 4 million Americans are infected with hepatitis C, which can irreparably damage the liver and lead to liver cancer, but because it inflicts injury slowly over decades, as many as 85% of carriers do not know that they have it. Baby boomers account for about 27% of the US population, but up to 75% of those infected with hepatitis C, possibly because injecting drugs — one infection route — was more common during their youth than in other eras. Last August, the CDC recommended screening the entire generation of people born between 1945 and 1965, as well as people in high-risk populations such as intravenous-drug users. The CDC predicts that generational screening would find an extra 800,000 cases and prevent at least 120,000 deaths. “We have an opportunity to make a real dent in the impact of the disease,” says Kimberly Page, an epidemiologist at the University of California, San Francisco.

Source: G. L. Davis et al. Gastroenterology 138, 513–521 (2010)

John’s doctor, infectious-disease specialist Kristen Marks of Weill Cornell Medical College in New York, says that screening is especially important for baby boomers because early symptoms of hepatitis C, such as fatigue and malaise, are difficult to distinguish from signs of ageing. People dismiss symptoms, says Marks, and some might not remember trying intravenous drugs in their youth. Even if they do, she adds, “they might not tell their doctor”. A peak in cases of liver scarring from untreated hepatitis C is expected in the next few years (see ‘An approaching burden’). But with the new drugs on the horizon, now is an optimistic time for treatment, says Marks. “Historically, not having good treatments was a disincentive for screening,” she says. “Now, I think there’s a renewed interest.”

But last November, the US Preventive Services Task Force (USPSTF), a panel of experts assembled by the US Department of Health and Human Services, released a draft statement giving the screening recommendation a ‘grade C’. That means that doctors should consider birth year when deciding whether to offer screening, but should take other factors into account. The mediocre grade could discourage many health-care providers — including Medicaid, the provider for people with low incomes — from pushing screenings.

As with its controversial recommendations in 2009 and 2012 to limit screening for breast and prostrate cancer, the USPSTF has tried to balance the benefits of screening against its costs and the risk of unnecessary treatment. The combination therapies used to combat hepatitis C can cost US$1,100 per week and last for up to a year, with severe side effects. Other treatments cost $4,100 per week. (Gilead declined to comment on the future price of sofosbuvir-based treatments.)

“We have an opportunity to make a real dent in the impact of the disease.”

Roger Chou, an internal-medicine specialist at Oregon Health and Science University in Portland and a scientific reviewer for the USPSTF, adds that in most patients, the disease is imperceptible: only 20% of people develop liver scarring in the first 20 years of infection, according to the CDC. Of the few baby boomers that might be caught through additional screening, says Chou, some will not need to be treated.

But new drugs, however expensive, could change the calculus for doctors and patients, says Mark Eckman, a physician at the University of Cincinnati in Ohio, who has calculated that even screening the entire US population would be cost effective given the financial and personal burdens of living with liver diseases (M. H. Eckman et al. Clin. Infect. Dis. 56, 1382–1393; 2013).

For example, sofosbuvir, which is one of a set of new antiviral drugs that specifically target hepatitis C rather than viruses in general, can achieve success rates above 90% in combination treatments of just three months. The drug inhibits the virus’s RNA polymerase, preventing viral replication. It is also being tested without the classic combination drug of pegylated interferon, which boosts the immune system but causes harsh side effects.

The USPSTF is still reviewing its draft recommendations, but it is likely to make a final decision in the next few months, well before approval of sofosbuvir or other new drugs could alter the calculations.

That is too bad, says David Thomas, a viral-hepatitis specialist at Johns Hopkins University in Baltimore, Maryland, who argues that the next generation of drugs helps to justify wide-scale screening. “It makes a pretty easy case for doing something different,” he says.

Nature 497, 18–19 (02 May 2013) doi:10.1038/497018a

Source

Sharecare Names Top 10 Social HealthMakers in Hepatitis C

PRESS RELEASE

May 1, 2013, 8:00 a.m. EDT

Today's 48- to 68-Year-Olds 5 Times More Likely Than Other Adults to Have Hep C

ATLANTA & SAN FRANCISCO, May 01, 2013 (BUSINESS WIRE) -- --May is Hepatitis Awareness Month--

According to the Centers for Disease Control and Prevention (CDC), people born between 1945 and 1965 are 5 times more likely than other adults to have hepatitis C--in fact, roughly 120,000 deaths could be prevented if all baby boomers were tested for hepatitis C. In light of these startling statistics, Sharecare, the health and wellness social network, has released its Top 10 Social HealthMakers in Hepatitis C. These informed individuals are leading online conversations about hepatitis C, providing invaluable insights on symptoms, treatment, support, and living with the virus.

Among them is a nurse who has treated and been treated for hepatitis C, a HepMag.com guest blogger who beat the virus with protease inhibitors, and an educator who has lived with the condition for 20 years. "Thanks to the latest treatments, four out of five HCV patients can spend the rest of their lives free of the disease," said Lucinda K. Porter, RN, #1 on the Sharecare Social HealthMakers list.

For Hepatitis Awareness Month in May, here are the Top 10 Social HealthMakers in Hepatitis C to follow:

1. Lucinda K. Porter, RN - LucindaPorterRN.com and HepMag.com

-- An RN, educator, consultant and author of Free from Hepatitis C who contracted hepatitis C in 1988, Porter served as clinical research nurse at Stanford's hepatology division and is active in hepatitis C support. Her second book Hepatitis C Treatment One Step at a Time: Inspiration and Practical Tips for Successful Treatment will be published September 2013.

2. John D. Carroll - FierceBiotech.com

-- FierceBiotech.com editor and a biotech analyst with 34 years prize-winning experience in journalism often covering hepatitis C drug releases and clinical trials, Carroll has written for Time magazine and The Dallas Morning News.

3. Margaret Dudley - Hepc-cured.com and HepMag.com

-- After contracting the virus via a tattoo needle and enduring the condition for six years before diagnosis, Dudley founded HCV Coalition for the Cure, petitioning to bring treatments to market.

4. Liz Highleyman - HIVandHepatitis.com

-- Freelance writer, editor and educator in public health, hepatitis B and C, HIV/AIDS, Highleyman is editor-in-chief of HIVandHepatitis.com and has written for HCV Advocate.

5. Adam Feuerstein - TheStreet.com

-- As senior columnist for The Street, Feuerstein reports on biotech stocks, including updates on hepatitis C drug releases and clinical trials.

6. Alan Franciscus - HCVadvocate.org

-- Franciscus is executive director of The Hepatitis C Support Project, which provides unbiased information, support and advocacy.

7. Karen Hoyt - iHelpC.com and HepMag.com

-- Founder of iHelpC.com, Hoyt beat the virus with protease inhibitors; she also guest blogs for HepMag.com.

8. Joseph S. Galati, MD - TexasLiver.com

-- A Houston-based liver disease specialist who has devoted his practice to the care of patients with acute and chronic liver disease, Dr. Galati also hosts a weekly health radio show, "Your Health First... with Dr. Galati."

9. Connie Welch - LifeBeyondHepatitisC.com

-- Blogger, sheep wrangler and educator who has lived with hepatitis C for 20 years.

10. Tom Horn - Treatment Action Group

-- Horn, a 20-year survivor of HIV, is the HIV Project Director for the Treatment Action Group (TAG) and writes for POZ.com and HepMag.com, addressing the importance of hepatitis C (HCV) testing, HIV/HCV co-infection and the staggering statistics around HCV infection.

Complete background information about all 10 Social HealthMakers in Hepatitis C can be found here: www.sharecare.com/static/top-ten-social-healthmakers.

Methodology

Sharecare Social HealthMakers (formerly SharecareNow) are among the most influential people in health and wellness on the Web, literally driving "conversations on the leading edge." They address a wide range of issues within specific topic areas while demonstrating consistent impact across multiple interactive channels--such as Twitter, Facebook, video and blogs. This impact is measured through a proprietary algorithm based on more than 100 individual metrics developed and powered by WCG, the marketing-leading digital communications agency, quantifying topic relevance, syndication, presence and reach. Prior Sharecare lists have identified Social HealthMakers in weight loss, infertility, heart disease, fitness, Alzheimer's disease and more.

About Sharecare

Sharecare is a health and wellness social network that connects people with experts, ranging from doctors and specialists to hospitals, healthcare companies and health-conscious consumers. The power behind the site's unique Q&A format is its collective wisdom, providing health-seeking consumers with answers reflecting multiple expert perspectives--greatly simplifying the search for quality information. Created by Jeff Arnold and Dr. Mehmet Oz in partnership with Harpo Productions, Sony Pictures Television and Discovery Communications, Sharecare allows people to ask, learn and act upon questions of health and wellness, creating an active community where knowledge is shared and put into practice--simply said, sharing care. Launched in 2010, Sharecare is based in Atlanta, GA.

-- Follow us on Twitter @SharecareNow

-- Like us on Facebook

-- Connect with us on LinkedIn

-- Read our Sharecare Blog

-- Watch us on YouTube

About WCG

Founded and led by chairman and CEO Jim Weiss, WCG is focused on integrated business solutions in the areas of innovation, change and growth for the world's leading companies and brands. WCG serves clients through a network of offices in San Francisco, New York, Chicago, Washington, D.C., Austin, Los Angeles and London. For more than a decade, WCG's seasoned professionals have specialized in providing analytics, content, engagement and strategy to a diverse set of clients across the consumer, technology, healthcare and pharmaceutical industries.

-- Follow us on Twitter: @wcgworld

-- Find us on Facebook

-- Read our CommonSense Blog

http://cts.businesswire.com/ct/CT?id=bwnews&sty=20130501005459r1&sid=cmtx4&distro=nx

SOURCE: Sharecare

Source

Hepatitis Outreach Network: A practical strategy for hepatitis screening with linkage to care in foreign-born communities

Journal of Hepatology
Volume 58, Issue 5 , Pages 890-897, May 2013

Ponni V. Perumalswami,  Stephanie H. Factor, Luciano Kapelusznik, Scott L. Friedman, Calvin Q. Pan, Charissa Chang, Frances Di Clemente, Douglas T. Dieterich

Division of Liver Diseases, The Mount Sinai Medical Center, Mount Sinai School of Medicine, NY, United States

Received 24 August 2012; received in revised form 26 December 2012; accepted 7 January 2013. published online 16 January 2013.

Abstract

Background & Aims

Many foreign-born persons in the US are at high risk of chronic hepatitis B (HBV) and C (HCV) infections, yet are not aware of their infection, and lack healthcare coverage or linkage to care.

Methods

A unique partnership, the Hepatitis Outreach Network, combines the expertise and resources of the Mount Sinai School of Medicine, the NYC Department of Health and Mental Hygiene, and community-based organizations, to provide education, screening and link to care in communities with high prevalence of chronic viral hepatitis. Comprehensive HBV and HCV screening identifies infected patients, who then receive further evaluation from either local or Mount Sinai physicians, combined with patient-navigators who organize follow-up visits.

Results

Of 1603 persons screened, 76 had HBV and 75 had HCV. Importantly, screening for HCV based on traditional risk factors would have missed 67% of those who tested positive. Of the 76 persons with HCV infection, 49 (64%) received a medical evaluation (26 with local providers and 23 at Mount Sinai). Of the 49 HCV-infected persons evaluated, treatment was recommended in 11 and begun in 8 (73%). Of the 76 persons with HBV infection, 43 (57%) received a medical evaluation (31 with local providers and 12 at Mount Sinai). Of the 43 HBV-infected persons evaluated, treatment was recommended and begun in 5 (100%).

Conclusions

Hepatitis Outreach Network has successfully established novel proof of concept for identifying HBV and HCV infections in foreign-born persons through use of several unique elements that effectively link them to care.

Keywords: Epidemiology, Patient navigators, Viral hepatitis, Testing, Treatment

PII: S0168-8278(13)00017-2

doi:10.1016/j.jhep.2013.01.004

© 2013 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved

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