Hep C poorly managed in haemophiliacs

Gastroenterology Update 11 JUNE 2013

Hugo Wilcken

People with inherited bleeding disorders are not being adequately monitored for hepatitis C, despite high levels found in those screened, say Australian experts.

Only 61% had been tested for hepatitis C, the researchers found in a study of 700 patients with bleeding disorders born after 1992.

Of those who had been tested, over half were hepatitis C antibody positive, with prevalence approaching 100% in patients with severe bleeding disorders.

But of those found to be positive, only a third had actually been treated, with a response rate of 45%.

Around 30% of patients with hepatitis C had had no follow-up with a clinician in the previous two years, the authors from the Alfred Hospital in Melbourne found.

A fifth of the 220 patients with hepatitis had died, including four from hepatocellular carcinoma and four from other liver-related complications. Over a fifth of patients with hepatitis C had never seen a specialist for their viral infection, the authors found.

Reporting in Haemophilia, the authors said high rates of disease in this population were largely due to exposure through blood transfusion before 1992, when blood products were first screened for the virus.

The authors said without testing, many of these patients would remain asymptomatic for years until irreversible complications set in.

But there was no comprehensive database to determine which patients might have received infected blood products, they noted, and patient self-reporting was a poor alternative as the blood may have been given to them as small children.

“Given the substantial morbidity and mortality associated with hepatitis C and new therapeutic options becoming available, it seems important to reengage patients to diagnose, offer treatment and monitor this infection,” they concluded.

Haemophilia 2013; online

%2012/06/2013%209:40:13%20AM&utm_content=" target=_blank>Source

Hep C knowledge gap endangering children

Gastroenterology Update 11 JUNE 2013

Hugo Wilcken

People at high risk of hepatitis C infection have a poor knowledge of the disease which is putting their children in danger, an Australian survey has found.

Less than half of those attending NSW methadone clinics admitted to being positive for the hepatitis C virus (HCV), a survey of 330 people found, although actual exposure rates in high-risk populations are generally double that.

Around half said their children had been tested for HCV but almost all believed their children’s status was negative, the authors from the University of Sydney said.

This clearly reflected a lack of understanding of the risk of vertical transmission from mother to child, as well as poor compliance with current guidelines which recommend the children of all high-risk people be tested, the authors said.

But when offered free testing for themselves and their children, only one participant accepted.

Writing in the Journal of Paediatrics and Child Health the authors said children of high-risk populations “remain an unrecognised cohort of HCV carriers and are particularly at risk of spreading and developing the infection in later life”.

The findings suggested “a striking non-adherence to best practice, a lack of awareness of HCV...and that many children in this high-risk population are lost to follow-up,” the authors said.

They underlined the need to screen children born to HCVpositive mothers and also to screen high-risk populations at least every one to two years.

The authors recommended active case monitoring through a HCV registry for high-risk people and their children, as well as further initiatives to raise awareness in the general population.

Journal of Paediatrics and Child Health 2013; online

%2012/06/2013%209:40:13%20AM&utm_content=" target=_blank>Source

Hepatitis C virus and human immunodeficiency virus transmission routes: Differences and similarities

World J Hepatol. 2013 May 27; 5(5): 234-236.

Published online 2013 May 27. doi: 10.4254/wjh.v5.i5.234.

©2013 Baishideng Publishing Group Co., Limited. All rights reserved.

Francesca Cainelli.

Francesca Cainelli, Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Botswana, Private Bag 00713, Gaborone, Botswana

Author contributions: Cainelli F wrote the paper.

Correspondence to: Dr. Francesca Cainelli, MD, Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Botswana, 4775 Notwane Rd, Private Bag 00713, Gaborone, Botswana. francescacainelli@yahoo.it

Telephone: +267-35-54563 Fax: +267-31-05979

Received March 24, 2013; Revised April 21, 2013; Accepted May 7, 2013;

Abstract

Bouare et al found that hepatitis C virus (HCV) infection in Malian women is mainly transmitted through medical procedures with contaminated supplies, and that human immunodeficiency virus (HIV) transmission is predominantly sexual. The results of this study confirm those of a recent case-control study in New York and Oregon which demonstrated that healthcare exposures represent an important source of new HCV infections in United States. HCV seroprevalence was only 0.2% in pregnant, young Malian women, indicating that hygiene improved in healthcare facilities over time. Heterosexual transmission of HCV is exceptional, and can occur, from males to females, in extremely rare occasions in case of vaginal mucosal damage or less rarely through anal intercourse. The Malian study did not show an association between HIV infection and hospitalization, transfusion, tattoo, dental care. Transmission by needle-stick injury occurs in 0.9%-2.2% of exposures from HCV-infected subjects and in 0.1%-0.3% of exposures from HIV-infected individuals. HCV is therefore more transmissible through percutaneous exposure.

Keywords: Hepatitis C virus, Human immunodeficiency virus, Transmission, Sub-Saharan Africa, Pregnant women

Core tip: The results of a number of studies have shown that hepatitis C virus (HCV) infection is mainly transmitted through medical procedures with contaminated supplies, whereas human immunodeficiency virus (HIV) transmission is predominantly sexual. Heterosexual transmission of HCV is exceptional and can occur, from males to females, in extremely rare occasions in case of vaginal mucosal damage or less rarely through anal intercourse. Transmission by needle-stick injury occurs in 0.9%-2.2% of exposures from HCV-infected subjects and in 0.1%-0.3% of exposures from HIV-infected individuals; therefore HCV is more transmissible through percutaneous exposure.

COMMENTARY ON HOT TOPICS

Bouare et al[¹], studying 1000 pregnant women in six reference health centers, and 231 older women who attended general practice in two hospitals in Mali, found that hepatitis C virus (HCV) infection is mainly transmitted through medical procedures with contaminated supplies rather than through blood transfusion, whereas human immunodeficiency virus (HIV) transmission is predominantly sexual.

The results of this study confirm those of a very recent case-control study done in three health departments that performed enhanced viral hepatitis surveillance in New York and Oregon and included reported cases of symptomatic acute hepatitis B and hepatitis C occurring in persons ≥ 55 years of age from 2006 to 2008; healthcare exposures were found to represent an important source of new HBV and HCV infections in United States[²]. Many other studies also found the same in different countries[^3-6]. It is reassuring that HCV seroprevalence was only 0.2% in pregnant (young) Malian women[¹], possibly indicating that hygiene improved in healthcare facilities over time. The results also confirm that heterosexual transmission of HCV is exceptional[^7-10]. Indeed heterosexual transmission of HCV from males to females can occur in extremely rare occasions in case of vaginal mucosal damage[¹¹] or less rarely through anal intercourse[^12,13].

What about HIV? The Malian study did not show an association between HIV infection and hospitalization, transfusion, tattoo, dental care. A significant decrease of HIV seroprevalence was detected in young women who used condoms for contraception more than for other purposes, whereas surprisingly HIV seroprevalence was significantly increased in young women using condoms mainly to prevent sexual infections[¹]. The authors interpreted these findings as suggestive of awareness of transmission and prevention of HIV infection only after contagion. However knowledge of vaginal sex as an HIV transmission risk and condom use as an HIV prevention strategy were associated with a higher likelihood of HIV infection in Mozambique and elsewhere in sub-Saharan Africa[¹⁴], inconsistent condom use was not related to the probability of HIV transmission per coital act in a study of Ugandan HIV discordant couples[¹⁵], and condom use was not negatively associated with incident HIV infection in a large study conducted in Benin, Ghana, India, Nigeria, and South Africa[¹⁶]. At least the latter of these surprising findings are likely to derive from the inaccuracy of self-reported data[¹⁷].

Transmission by needle-stick injury occurs in 0.9%-2.2% of exposures from HCV-infected subjects[^18,19] and in 0.1%-0.3% of exposures from HIV-infected individuals[²⁰]; therefore HCV is more transmissible through percutaneous exposure. It has not been definitively established why HCV is much less transmissible than HIV by heterosexual contact, and more infectious through parenteral exposure. Although low infectivity of HCV by vaginal intercourse has been related to low titres in genital secretions, titres of free HIV are also low. It may be that as infection of tissue dendritic DC-SIGN(+)-DC cells and localised replication in cervico-vaginal tissues are of fundamental importance for HIV infection of exposed individuals[²¹], the lack of target cells in the genital tract may prevent infection by HCV through vaginal intercourse.

Footnotes

P- Reviewers Hou WH, Kagawa T, Quer J, Sira MM S- Editor Gou SX L- Editor A E- Editor Li JY

References

1. Bouare N, Gothot A, Delwaide J, Bontems S, Vaira D, Seidel L, Gerard P, Gerard C. Epidemiological profiles of human immunodeficiency virus and hepatitis C virus infections in Malian women: Risk factors and relevance of disparities. World J Hepatol. 2013;5:196-205. [DOI]

2. Perz JF, Grytdal S, Beck S, Fireteanu AM, Poissant T, Rizzo E, Bornschlegel K, Thomas A, Balter S, Miller J. Case-control study of hepatitis B and hepatitis C in older adults: Do healthcare exposures contribute to burden of new infections?. Hepatology. 2013;57:917-924.[PubMed] [DOI]

3. Baha W, Foullous A, Dersi N, They-They TP, Alaoui KE, Nourichafi N, Oukkache B, Lazar F, Benjelloun S, Ennaji MM. Prevalence and risk factors of hepatitis B and C virus infections among the general population and blood donors in Morocco. BMC Public Health. 2013;13:50.[PubMed] [DOI]

4. Spada E, Mele A, Mariano A, Zuccaro O, Tosti ME. Risk factors for and incidence of acute hepatitis C after the achievement of blood supply safety in Italy: results from the national surveillance system. J Med Virol. 2013;85:433-440.[PubMed] [DOI]

5. Flisiak R, Halota W, Horban A, Juszczyk J, Pawlowska M, Simon K. Prevalence and risk factors of HCV infection in Poland. Eur J Gastroenterol Hepatol. 2011;23:1213-1217.[PubMed] [DOI]

6. Kim JY, Won JE, Jeong SH, Park SJ, Hwang SG, Kang SK, Bae SH, Kim YS, Lee HC. Acute hepatitis C in Korea: different modes of infection, high rate of spontaneous recovery, and low rate of seroconversion. J Med Virol. 2011;83:1195-1202.[PubMed] [DOI]

7. Terrault NA, Dodge JL, Murphy EL, Tavis JE, Kiss A, Levin TR, Gish RG, Busch MP, Reingold AL, Alter MJ. Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study. Hepatology. 2013;57:881-889.[PubMed] [DOI]

8. Ndong-Atome GR, Njouom R, Padilla C, Bisvigou U, Makuwa M, Kazanji M. Absence of intrafamilial transmission of hepatitis C virus and low risk for sexual transmission in rural central Africa indicate a cohort effect. J Clin Virol. 2009;45:349-353.[PubMed] [DOI]

9. Hajiani E, Masjedizadeh R, Hashemi J, Azmi M, Rajabi T. Hepatis C virus transmission and its risk factors within families of patients infected with hepatitis C virus in southern Iran: Khuzestan. World J Gastroenterol. 2006;12:7025-7028.[PubMed]

10. Vandelli C, Renzo F, Romanò L, Tisminetzky S, De Palma M, Stroffolini T, Ventura E, Zanetti A. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol. 2004;99:855-859.[PubMed] [DOI]

11. Quer J, Murillo P, Esteban JI, Martell M, Esteban R, Guardia J. Sexual transmission of hepatitis C virus from a patient with chronic disease to his sex partner after removal of an intrauterine device. Sex Transm Dis. 2003;30:470-471.[PubMed]

12. Healey CJ, Smith DB, Walker JL, Holmes EC, Fleming KA, Chapman RW, Simmonds P. Acute hepatitis C infection after sexual exposure. Gut. 1995;36:148-150.[PubMed] [DOI]

13. Halfon P, Riflet H, Renou C, Quentin Y, Cacoub P. Molecular evidence of male-to-female sexual transmission of hepatitis C virus after vaginal and anal intercourse. J Clin Microbiol. 2001;39:1204-1206.[PubMed] [DOI]

14. Brewer DD. Knowledge of blood-borne transmission risk is inversely associated with HIV infection in sub-Saharan Africa. J Infect Dev Ctries. 2011;5:182-198.[PubMed] [DOI]

15. Wawer MJ, Gray RH, Sewankambo NK, Serwadda D, Li X, Laeyendecker O, Kiwanuka N, Kigozi G, Kiddugavu M, Lutalo T. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis. 2005;191:1403-1409.[PubMed] [DOI]

16. Feldblum PJ, Lie CC, Weaver MA, Van Damme L, Halpern V, Adeiga A, Bakare R, Schwartz J, Becker M, Solomon S. Baseline factors associated with incident HIV and STI in four microbicide trials. Sex Transm Dis. 2010;37:594-601.[PubMed] [DOI]

17. Turner AN, De Kock AE, Meehan-Ritter A, Blanchard K, Sebola MH, Hoosen AA, Coetzee N, Ellertson C. Many vaginal microbicide trial participants acknowledged they had misreported sensitive sexual behavior in face-to-face interviews. J Clin Epidemiol. 2009;62:759-765.[PubMed]

18. Ryoo SM, Kim WY, Kim W, Lim KS, Lee CC, Woo JH. Transmission of hepatitis C virus by occupational percutaneous injuries in South Korea. J Formos Med Assoc. 2012;111:113-117.[PubMed] [DOI]

19. Tomkins SE, Elford J, Nichols T, Aston J, Cliffe SJ, Roy K, Grime P, Ncube FM. Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data. J Viral Hepat. 2012;19:199-204.[PubMed] [DOI]

20. Ippolito G, Puro V, De Carli G. The risk of occupational human immunodeficiency virus infection in health care workers. Italian Multicenter Study. The Italian Study Group on Occupational Risk of HIV infection. Arch Intern Med. 1993;153:1451-1458.[PubMed] [DOI]

21. van den Berg LM, Geijtenbeek TB. Antiviral immune responses by human langerhans cells and dendritic cells in HIV-1 infection. Adv Exp Med Biol. 2013;762:45-70.[PubMed] [DOI]

Source

Bill would provide Hep-C testing for more NY'ers

Photo by Cassandra Hamdan.

By RICHARD MOODY

June 11, 2013

A group of about 50 advocates dressed in black and white T-shirts with "Vocal New York" printed across their fronts crowded the Million Dollar Staircase in the Capitol; signs, that said, "Hep C Testing = Saved Lives," and "Fight Hep C," waved in the air; chants of, "No justice, no peace," and "End Hep-C" reverberated up and down the staircase.

"You are all making history here," Assemblyman Zebrowski said to the group of advocates from Vocal New York, a grassroots advocacy group that speaks on the behalf of low-income people, and concerned individuals as they rallied behind a bill (A.1286/S.2750) — the first piece of legislation of its kind nationally — to add a new section to the public health law requiring certain health service providers to offer Hepatitis-C tests to people born between 1945 and 1965. And if the test should come out positive the provider must offer follow-up health care ¬— or refer the infected individual to a provider who can — including a Hepatitis-C diagnostic test.

The bill also requires the state health commissioner to evaluate the impact of the legislation and report the findings to the governor and Legislature.

The bill passed in the Assembly on Monday and advanced into its third reading in the Senate on the same day. The bill was sponsored in the Assembly by Assemblyman Kenneth Zebrowski, D-New City, whose father, also an assemblyman, died in 2007 of Hepatitis-C. "Three to five million people have Hep-C and most of them don't even know," Zebrowski said. He seemed optimistic about the possibility of the bill passing in the Senate saying that all it needs is a "little push."

"We will get this all signed into law."

Assemblywoman Joan Millman, D-Brooklyn, who co-sponsored the bill, said her message was simple, "We need to pass this bill."

The rally was emceed by Bobby Tolbert, a board member of Vocal New York, who tried to buy time for Sen. Kemp Hannon, R-Garden City, sponsor of the bill in the Senate, to arrive to the press event by opening the floor to personal testimonies. One such testimony was given by a Diane Nunez who was diagnosed with Hepatitis-C in 1998 and went for treatment in 2003. "This is a pandemic in our communities," said Nunez, "We have to end Hep-C."

Hadiyah Charles, a longtime advocate HIV/AIDES prevention associated with the Lower East Side Harm Reduction Coalition, praised New York for taking a big step in national history and said that with this legislation "New York should cause a domino effect" of other states passing similar legislation.

Sammy Santiago, a concerned individual who was tested in 1996 for Hepatitis-C and was declared "undetectable" and earlier this year found out he had cirrhosis of the liver, has been getting treatment for Hepatitis-C for four months. "In the first four weeks I was declared undetectable again," Santiago said. Santiago stressed the importance of getting tested for Hepatitis-C, "That's what's important: we all need to be educated."

George Santana of the CitiWide Harm Reduction Coalition spoke about his experience after being diagnosed with Hepatitis-C. "I've done the treatment. It sucks, anyone who has done it knows what I'm saying, but it was worth it," Santana said. "We must continue to fight, because I know deep in my heart this bill will pass."

Source

Also See: NBLCA Supports Proposed New York State Legislation That Would Expand Testing for Hepatitis C Virus in Baby Boomers

Global Commission on Drug Policy: Hepatitis C an epidemic

Hepatitis C kills about 350,000 people worldwide every year and the World Health Organization (WHO) estimates that about 150 million people are chronically infected. In the Americas, between seven million and nine million are infected with the disease, according to the Pan American Health Organization (PAHO). (Francois Nascimbeni/AFP)

Between seven million and nine million people in the Americas are infected with the disease.

By Ezra Fieser for Infosurhoy.com – 11/06/2013

SANTO DOMINGO, Dominican Republic – The counter-narcotics fight is fueling an international hepatitis C epidemic, according to a new report, leading prominent world and Latin American figures to call on countries to decriminalize drug use and focus on treatment.

“The Negative Impact of the War on Drugs on Public Health: the Hidden Hepatitis C Epidemic,” produced by Global Commission on Drug Policy, stated that about five of every eight intravenous drug users are living with the disease.

The World Health Organization (WHO) estimates that about 150 million people are chronically infected with hepatitis C, which kills about 350,000 people a year – most of whom develop cirrhosis or cancer.

In the Americas, between seven and nine million are infected with the disease, according to the Pan American Health Organization (PAHO). The organization doesn’t estimate the number of deaths specifically caused by the disease, but according to PAHO statistics about 16,500 people die of related disease – such as cirrhosis – annually.

About 10 million people living with the disease are intravenous drug users. But the Global Commission on Drug Policy said the disease is needlessly spread due to outdated laws and policies that target drug users.

Hepatitis C, one of the five types of viral hepatitis diseases that affect the liver, is contracted through contact with the blood of infected persons, meaning intravenous drug users run a high risk of contracting the disease. It is a leading cause of liver transplants.

Infection rates are highest in countries in Central Asia and Eastern Europe, where as many as 90% of intravenous drug users are infected.

The commission carries the weight of several prominent figures. Former United Nations Secretary-General Kofi Annan, seven former presidents and Virgin Group founder Richard Branson are among the commission’s members.

Former Brazilian President Fernando Henrique Cardoso, the commission’s chairman, said hepatitis C is “both preventable and curable when public health is at the core of drug response.”

With the report, “we are exposing the links between repressive drug policies and the spread of hepatitis C, another massive and deadly global epidemic,” Cardoso said in a video message introducing the study. “This is another concrete example of the failure and negative impacts of repressive drug policies around the world.”

The commission previously had warned of the link between criminalized drug use and the spread of HIV/AIDS. By linking drug use to hepatitis C, the commission hopes to provide another example in the argument that drug use should be decriminalized.

Cardoso also said it’s a human rights issue.

“Though human rights abuses are widespread in most parts of the world, they come about in different ways,” he said. “In Latin America, the main issue is mass incarceration, violence and corruption and the strengthening of organized crime.”

Specifically, the commission is recommending governments:

• End criminalization and mass incarceration of drug users;
• Redirect money currently dedicated to the counter-narcotics fight toward public health projects aimed at drug users;
• Make sterile syringes available and offer treatment programs, such as opioid substitution therapy for heroin users;
• Better report hepatitis C cases by improving surveillance systems and other measures;
• Reduce the cost of medicines that can treat hepatitis C by negotiating with pharmaceutical companies and making the drugs more widely available.

The report was released in advance of the International Harm Reduction Conference in Lithuania, which began June 9.

Meantime, last week’s 43rd General Assembly of the OAS ended with foreign ministers’ creating a roadmap they hope leads to long-term renewal of their regional drug policy in 2016.

Officials at the General Assembly, which was held in the Guatemalan city of Antigua, said they will convene a special meeting during the first half of 2014 to outline the counter-narcotics strategy that will be discussed when the OAS holds its 44th General Assembly in June 2014 in Paraguay.

“We have already reached a consensus and agreed that our final declaration will include changes to the current anti-drug model,” Guatemalan Foreign Minister Fernando Carrera told reporters. “We already have some ideas on how to change drug-fighting policies.”

Source

Ukraine Injects Addicts With Hope

Tuesday, June 11, 2013 - 16:46 Inter Press Service

VILNIUS, Lithuania, Jun 11 (IPS) - As former presidents, senior diplomats and experts meet in the Lithuanian capital to discuss a litany of rights abuses, lethal epidemics and social destruction caused by repressive drug policies in Eastern Europe and Central Asia, pockets of hope for drug reform are emerging across the region.

Eastern Europe and Central Asia (EECA) is home to over 3.7 million people who inject drugs - almost a quarter of people who inject worldwide. Injecting drug use is fuelling HIV and hepatitis C epidemics in most EECA countries - almost a third of injecting drug users in the region are thought to be living with HIV while even more are infected with hepatitis C.

Many EECA countries also have some of the world’s strictest legislation on drugs. Lengthy jail sentences are routinely imposed for even the most minor drugs offences, and government approaches to harm reduction – including needle exchanges, opioid substitution treatment and social support systems - range from apathetic to actively obstructive.

However, as the enormous scale of the HIV/AIDS and hepatitis C epidemics has emerged and authorities have begun to realise the massive public health implications of drug use, some governments are softening their drugs policies, albeit mildly.

Michel Kazatchine, the UN Secretary General’s special envoy on HIV/AIDS for East Europe and Central Asia, told IPS: “Countries across the Eurasian region, from the Ukraine to Belarus and all the way to Central Asia are showing signs of moving in a more positive direction on harm reduction.”

Delegates at the International Harm Reduction Conference in Vilnius Jun. 9-12 – which brought together more than 800 scientists, politicians, researchers, health workers, doctors and drug user activists from across the world – repeatedly heard how state drug policy across the region remains widely rooted in repression and criminalisation, compounding public health problems and having no effect on reducing drug use.

Drug addicts who spoke to IPS at the conference told stories of police waiting outside harm reduction service centres to arrest addicts for having dirty needles on them, and using the residue in their needles as proof of possession.

But what also emerged from the conference was the success of harm reduction efforts in some countries and surprising reform plans in others.

Georgia’s justice minister, Tea Tsulukiani, outlined plans for sweeping reforms of the former Soviet state’s drug policy. At present harm reduction services are not legalised, there is no treatment for drug users in prisons, and possession of even the smallest amounts of drugs can end in an 11-year jail sentence.

The ministry wants to decriminalise possession of small amounts of both soft and hard drugs, overhaul healthcare services for drug users, and legalise harm reduction.

Tsulukiani told IPS: “At the moment Georgia has a repressive machine to deal with drugs. This needs to be changed to a system that is fair and human.”

In Kazakhstan, meanwhile, the health ministry at the end of last year expanded opioid substitution therapy programmes, and there has been a significant upgrade of funding for harm reduction programmes. It has also introduced a large programme to tackle hepatitis C.

But arguably the greatest changes have been seen in Ukraine, which is already being hailed as a shining example for the rest of the region of how to implement harm reduction programmes and to successfully engage authorities on drug policy reforms.

Ukraine has struggled for the last decade with one of the fastest growing HIV/AIDS epidemics in the world, driven by injection drug use. There are an estimated 290,000 injecting drug users in Ukraine.

But last year, for the first time, the rate of new HIV infections in Ukraine dropped. This has been put down to the widespread implementation of harm reduction programmes.

The Ukrainian harm reduction group International HIV/AIDS Alliance Ukraine implements the largest HIV prevention programme in the EECA, supporting 170,000 drug users in more than 300 cities. The government also recently approved the country’s first hepatitis C programme to combat the epidemic in the country.

The programme was approved largely after sustained pressure from civil society groups who led dialogue with authorities, persuading them of the public health risk of the epidemic.

Andrij Klepikov, executive director of International HIV/AIDS Alliance Ukraine, said other countries in the region should try to follow their lead.

He told IPS: “We need to get the message out about our success. Our programmes have been a success and there is so much we can easily share with other countries in the region - there is no language barrier because Russian is widely spoken around the region and there are similar situations in many countries with regard to the drug problem and related health problems.

“Our experience could be really useful for them.”

Tsulukiani told IPS that Ukraine’s implementation of harm reduction services was one example which her ministry was looking at as it formulates a body of evidence to present to other ministries “to persuade them that by implementing reforms the situation with drug use will not get worse in Georgia.”

But as delegates at the conference heard, for all the progress in these countries, drug users continue to face human rights abuses, a chronic lack of access to harm reduction services and criminalisation which does nothing to combat addiction. Prisons remain flooded with illicit drugs and are breeding grounds for diseases such as HIV and hepatitis.

Tsulukiani told IPS that one of the “pillars” of the reforms she wants to push through in Georgia are changes in healthcare services for drug users and particularly for incarcerated drug users.

“Drug users are seen as criminals and put in prison. All they get there is detox, no treatment, and they come out psychologically destroyed,” she said.

However, some people are hopeful that the situation in the region can be changed for the better, as the example of Ukraine has shown.

Alexander Kwasniewksi, former president of Poland and member of the Global Commission on Drug Policy, told IPS: “It’s not all bad news in the EECA, there are positive things happening, such as law changes and the scaling-up of services in some countries.

“And while much, much more still needs to be done, we can look at the example of the Ukraine and see that with enough pressure and work from NGOs, change can definitely be effected.”

Source

Novel Liver Stem Cell Model Could Speed Up Process for Developing New Drugs

In the latest issue of STEM CELLS Translational Medicine, a research team reports a new method which involves the creation of a highly stable and sensitive liver stem cell model.

Durham, NC (PRWEB) June 11, 2013

The path to bringing a new drug to market is, simply put, a rocky one. Not only is it estimated to take over 12 years at an average price tag running anywhere between US $800 million and US $2 billion, but more often than not the new drug never makes it through the process.

But now a research team reports that it has developed a way to speed up the process. Their work, which involves the creation of a highly stable and sensitive liver stem cell model, is reported in the latest issue of STEM CELLS Translational Medicine.

“Liver toxicity is the second most common cause of human drug failure,” explained David Hay, Ph.D., of the University of Edinburgh’s MRC Centre for Regenerative Medicine, who led the team made up of university colleagues and scientists from Bristol-Myers Squibb, Princeton, N.J. “But one major bottleneck in safety testing new drugs has been finding a routine supply of good quality primary human hepatocytes from the desired genetic background.”

Scientists have long believed that finding an efficient way to force pluripotent stem cells (PSCs) to develop into hepatocytes — liver cells — could be the way around the problem. “But faithfully recapitulating human physiology in a dish from a renewable source remains a holy grail for medicine and the pharmaceutical industry,” Dr. Hay noted.

“Many procedures have been described that, to a limited extent, exhibit human-tissue-specific function in vitro but incomplete cellular differentiation and/or the loss of cell phenotype after they differentiate. Using our knowledge in pharmacology, stem cell biology and materials chemistry, we developed a highly stable and sensitive model.”

Their method involved expanding PSCs and driving their differentiation to hepatocytes, then replating them onto a synthetic surface. The results yielded active cell populations that displayed stable function for over two weeks in vitro.

“The scalable nature of our model combined with the interchangeable genetic element demonstrates clear advantages over the erratic supply of highly variable human hepatocytes from deceased specimens,” Dr. Hay added. “We believe our approach is important and will likely contribute to improvements in drug safety testing.”

“This model was compared to human liver cells from deceased donors and found to be equivalent, suggesting that stem cell-derived hepatocyles have potential to improve the preclinical assessment of human liver toxicity,” said Anthony Atala, M.D., Editor of STEM CELLS Translational Medicine and director of the Wake Forest Institute for Regenerative Medicine. “

The full article, “Developing high fidelity hepatotoxicity models from pluripotent stem cells,” can be accessed at http://www.stemcellstm.com.

About STEM CELLS Translational Medicine: STEM CELLS TRANSLATIONAL MEDICINE (SCTM), published by AlphaMed Press, is a monthly peer-reviewed publication dedicated to significantly advancing the clinical utilization of stem cell molecular and cellular biology. By bridging stem cell research and clinical trials, SCTM will help move applications of these critical investigations closer to accepted best practices.

About AlphaMed Press: Established in 1983, AlphaMed Press with offices in Durham, NC, San Francisco, CA, and Belfast, Northern Ireland, publishes two other internationally renowned peer-reviewed journals: STEM CELLS® (http://www.StemCells.com), celebrating its 31st anniversary in 2013, is the world's first journal devoted to this fast paced field of research. The Oncologist® (http://www.TheOncologist.com), also a monthly peer-reviewed publication, entering its 18th year, is devoted to community and hospital-based oncologists and physicians entrusted with cancer patient care. All three journals are premier periodicals with globally recognized editorial boards dedicated to advancing knowledge and education in their focused disciplines.

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Organ transplants - to donate or not

By Liu Zhihua
China Daily/Asia News Network
Tuesday, Jun 11, 2013

Serious health problems, such as heart or kidney or liver failure, cancer, blindness, or Parkinson's disease affect millions of people around the world, altering the quality of life and putting a major burden on family members and society.

In some cases, an organ transplant may be the only treatment or lifeline available - for those who have access to the procedure. But, even then, there is such high demand for organs that many people can die before they qualify for a suitable organ.

According to the Red Cross Society of China, which runs a State-sanctioned organ donor programme, China has about 1.5 million people in need of an organ transplant every year, but only about 10,000 can undergo the procedure.

The reason for this are age-old but can be illustrated by a recent incident in April. When the family of a trucker, in Wuhan, Hubei province who had died donated his organs and helped five people on the transplant list, the news spread like wildfire on the Internet. The man, Chen Gang, 35, had suddenly lost consciousness on April 21, at work, and by the second day when there appeared to be no hope of saving him, his family told the doctors they wanted to let someone else benefit from his organs.

For Yin Shumin, a 45-year-old farmer in Henan, and four other men, that one decision was a major turning-point. Yin underwent a life-saving heart transplant at Wuhan's Union Hospital, on April 23, something he had been waiting for since January.

Yin's wife, who didn't give her name, had this to say, "No one could possibly understand how worried I was while we were waiting for the results. He was getting weaker every day and the doctors explained that if he couldn't get a proper heart, he would die in a few months."

The same day that Yin was operated on, a patient he had met in the hospital, who had been waiting for a heart transplant a long time, died.

Where are the donors?

Yin was lucky getting a perfect match, out of several dozen people with heart problems who were still waiting.

Dong Nianguo, the chief surgeon working on Yin and a major specialist in that field, noted regretfully, "A lot of people die waiting for a heart."

But, with so few organ donors and the huge difference between the need and the supply, things can look rather grim. In contrast, the surgical procedures for many organ transplants in China are mature enough to ensure a high rate of success, but unfortunately for those in need of a heart, kidney, liver, lung, or a cornea, even with the expert service, prospects can be quite dim.

So, "When something unusual happens, it makes the news, and people notice what Chen and his family did, because so few people do the same", Dong said.

In this regard, there was a national pilot programme that started in 2010, to solicit organ donations, in 19 provinces, including Hubei. Red Cross branches have set up offices to make people more aware of the importance of organ donations and to connect with area hospitals to look for potential donors.

Personnel from these offices talk with dying patients or their family members to try to get their permission to donate. And, a computerized system tracks the needs of waiting patients in relation to the state of the disease and the distance from a potential donor, then identifies the most likely recipient.

Chen and his family who were willing to donate his organs became a part of this system. But statistics show, by the end of February, only 659 people had donated organs, a total of only 1,804, via this system.

Xiu Dianrong, a liver transplant surgeon at Peking University's No 3 Hospital, said, "There are a lot of potential donors, but few become donors."

At Xiu's hospital, one of the earliest to undertake liver transplants in China, the lack of organs is the biggest major obstacle to saving lives. It is certainly not the technical difficulties.

The Chinese have little exposure to a philosophical approach to death, which is an unpleasant cultural topic, and few can accept the idea of donating organs of a loved one who is dying, or even talk about the possibility, Xiu commented.

But, Xiu continues, death, as well as illness and aging, need to be perceived as a natural part of life, and people should not be afraid.

Alternatives

Dong, the cardiac surgeon, also expresses the hope that more people will change their attitude toward donating organs and understand the meaning of such behaviour and its impact on others.

Meanwhile, not every organ for a transplant necessarily needs to come from a human, some people are already looking to animals for the solution.

Historically, doctors have made attempts to replace failing human organs with those of animals such as pigs or monkeys, but these xenotransplants, or inter-species transplants, have failed for unknown or unresolved reasons.

In recent years, there have been some breakthroughs. In the mid 1990s, scientists in the US were pioneers with a procedure that used pigs as the most likely organ choice among animals.

Now, with the development of genetic technology, researchers have been looking for ways to genetically modify donor animals to prevent organ rejection, and more genetically modified pigs have become available, with human genes, to avoid a human immune system reaction.

On May 8, 2013 , doctors at the Xijing Hospital in Xi'an, Shaanxi, announced that they had planted part of a liver from a genetically altered pig to a monkey.

Source

Italy leads Europe in hepatitis C cases

Milan

11/06/2013

Some 3% of population infected, over half with the worst kind

Milan, June 11 - Italy leads Europe in cases of hepatitis C with 3% of the population infected, more than half of whom suffer from the most difficult variety to treat, leading experts said Tuesday. Some 1.6 million people carry the liver infection in Italy and 55% of them are afflicted with genotype 1, a particularly infectious strain of the disease, said doctors at the Premio Giornalistico Riccardo Tomassetti conference on virology in Milan. "At least one million Italians are chronic carriers of the infection," said Massimo Colombo, director of special treatments and organ transplants at Milan's Maggiore hospital. "One third of these people have developed or are developing serious liver infections". The majority of patients contracted the virus in the 1970s and 80s, Colombo said, with infected blood transfusions, or from health instruments such as hypodermic needles that were not sterilized. "But another 200-300,000 contracted the disease due to risky behaviour such as unprotected sex, piercings and tattoos. "In addition we should include a substantial number of migrants who come from areas with high levels of hepatitis C".

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Despite the Numerous Agents in Development for the Treatment of Chronic HCV Infections, a Notable Share of Physicians in Europe Lack Awareness of the HCV Pipeline

One Third of Surveyed Specialists in the EU5 were Unable to Cite Any New Therapy in Development for HCV, According to a New Report from BioTrends Research Group

EXTON, Pa., June 11, 2013 /PRNewswire/ -- BioTrends Research Group, one of the world's leading research and advisory firms for specialized biopharmaceutical issues, finds in their TreatmentTrends^®: Hepatitis C Virus (EU) report, that surveyed gastroenterologists and hepatologists in Spain and France are more likely to be aware of emerging HCV drugs than their counterparts in the United Kingdom, Italy and Germany.  Among physicians with unaided awareness of HCV therapies in development, 42 percent specifically recalled Gilead's sofosbuvir, while only 13 percent cited Janssen/Medivir's simeprevir – two products expected to launch in Europe in the first half of 2014. When asked about the most desired attributes in new HCV therapies, surveyed EU5 physicians pointed to high SVR rates in both genotype 1 patients and in patients who have experienced previous treatment failure.

(Logo: http://photos.prnewswire.com/prnh/20130103/MM36805LOGO )

"EU5 physicians expect sofosbuvir and simeprevir to improve cure rates in genotype 1 and treatment-experienced patients. However, our analyses reveals that there are several additional attributes, including pan-genotypic activity, simplified regimens and ribavirin-sparing efficacy, where follow-on therapies can differentiate themselves from currently available treatments and future regimens," said Director of Infectious Diseases Brenda Perez-Cheeks, Ph.D. "Looking ahead, these opportunities will likely become important as the HCV space becomes increasingly competitive with highly efficacious direct-acting antivirals and regimens. Consequently, novel agents will have to carve out niche opportunities for market penetration."

Surveyed EU5 physicians also noted the uptake of the protease inhibitors (PIs) as the focus of treatment shifts in the past six months. However, trending analysis of physician-reported prescribing between 2012 and 2013 indicates that PI triple therapy uptake is stabilizing in France and Germany, while PI-based therapy has seen gains in on-treatment patient shares in both the UK and Spain. Further, Janssen/Vertex's Incivo continues to outpace its competitor Merck/Roche's Victrelis on usage, brand perception and physician satisfaction. 

The TreatmentTrends^®: Hepatitis C Virus (EU) report covers the use of agents for the treatment of HCV infections in the EU5 based on primary market research with 258 gastroenterologists and hepatologists. This annual study focuses on current and future use of HCV treatment regimens, patient market share, perceived strengths and weaknesses of the key brands, barriers to broader usage and sales force performance. The report also explores the potential impact of regimens in development, including ABT-267, ABT-333, ABT-450, BI-207127, asunaprevir, daclatasvir, faldaprevir, ledipasvir simeprevir and sofosbuvir. The biannual study entitled TreatmentTrends^®: Hepatitis C Virus (US), Wave 1, which provides insight into the treatment of chronic HCV infections in the U.S. from the perspective of gastroenterologists, hepatologists and infectious diseases specialists, is also now available.

About BioTrends Research Group
BioTrends Research Group provides syndicated and custom primary market research to pharmaceutical manufacturers competing in clinically evolving, specialty pharmaceutical markets. For information on BioTrends publications and research capabilities, please visit www.bio-trends.com. BioTrends is a Decision Resources Group company.

About Decision Resources Group
Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at www.DecisionResourcesGroup.com.

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ccomfort@dresources.com

SOURCE BioTrends Research Group

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