Award for hepatitis community focus

Posted at 11:58am Sunday 15th Dec, 2013

Focusing on Asian, Maori and Pacific Island ethnicities is what has won The Hepatitis Foundation of New Zealand a community service award.

More than 14,000 people affected by hepatitis B are enrolled in The Hepatitis Foundation of New Zealand programmes.

Health Minister Tony Ryall, presenting the award to The Hepatitis Foundation of New Zealand CEO, John Hornell.

A hepatitis C pilot programme is currently running in the Bay of Plenty.

Hepatitis B is a disease affecting many people with the majority of people affected of Asian, Maori and Pacific Island ethnicity.

Health Minister Tony Ryall presented the award at the New Zealand Health Foundation for Asian and Ethnic Communities ceremony in Auckland last month.

“We endeavour to work effectively with different ethnic groups in the community,” says The Hepatitis Foundation of New Zealand CEO John Hornell.

A big part of this is being aware of and understanding the cultural diversity of New Zealand, says John.

“I would like to thank the New Zealand Health Foundation for Asian and Ethnic Communities for recognising our commitment to addressing chronic hepatitis in the Chinese and Asian communities.”

The Hepatitis Foundation of New Zealand offers free services in the community to improve health outcomes for people living with chronic hepatitis B and/or C.

Source

2014 Could Be a Breakthrough Year for More Than 3 Million Hepatitis-C Sufferers

Provided by The Motley Fool

By Sean Williams | More Articles
December 14, 2013 | Comments (0)

The biopharmaceutical sector can sometimes be rife with big discoveries or a wasteland of failure, depending on the nature of a disease.

Alzheimer's disease, for example, has been a difficult to treat condition, as the underlying cause of the disease is still being debated and it's extremely difficult to penetrate the blood-brain barrier with most modern medicines. Most types of cancer are another sticking point. Although biopharmaceutical companies have developed targeted therapies that slow the progression of the disease in many instances, we're nowhere near a cure for stemming the production of cancer cells.

However, once in a while a ray of bright line shines through, such as with hepatitis-C, which has seen a remarkable transformation occur in just the past two and a half years.

Source: CDC Foundation.

A huge leap forward
Before May 2011, the standard therapy for treating hepatitis-C, a viral disease of the liver that can lead to cirrhosis and/or liver cancer, was a combination of pegylated interferon and a ribavirin. This combination therapy induced no response in about half the patients it was used on and was only marginally effective on many of those who did exhibit a response.

Then along came Vertex Pharmaceuticals(NASDAQ: VRTX ) with its oral medication, Incivek, which drastically changed the treatment landscape. Although still given in combination with interferon and a ribavirin, Incivek greatly improved patients' sustained virologic response (the level at which no detectable levels of the HCV virus can be found) after 24 weeks by 20% to 45% over the previous standard of treatment depending on the trial. Not surprisingly, Incivek became the quickest drug to ever reach $1 billion in sales (less than eight months), but also lost the majority of its revenue nearly as fast as it ceded ground to up-and-coming treatments.

This upcoming year is looking as if it will be every bit as exciting for investors as it will be for some 3.2 million hepatitis-C sufferers in the U.S. with the expected unleashing of two new (and in some cases interferon-free) hepatitis-C therapies which both appear to deliver a massive improvement in patient quality of life as well as vastly better SVRs.

A new drug emerges
A little more than a week ago, Gilead Sciences (NASDAQ: GILD ) received approval for its oral hepatitis-C drug, Sovaldi (previously sofosbuvir) for the treatment of genotypes 1 through 4. According to the World Health Organization there are 11 hepatitis-C subtypes, but for all intents and purposes, genotype 1 (by far the most common), 2, and 3 comprise somewhere around 95% of all hepatitis-C cases based on every meta-analysis trial I've ever stumbled across.

Gilead's drug, Sovaldi, is a breakthrough in that it's the first hepatitis-C therapy that can be administered to genotype 2 and 3 patients (between 20% and 25% of all cases) without the need for interferon. Since interferon has the side effect of delivering flu-like symptoms to patients, this is a huge improvement in patient quality of life.

The other major advancement with Sovaldi was a drastically improved SVR across the board. While Incivek delivered a 79% SVR after 24-weeks, Sovaldi produced a 90% SVR after just 12 weeks in genotype 1 patients when given with interferon and a ribavirin. In addition, it was, as you might imagine, particularly effective on genotype 2 and 3 patients. It demonstrated a cumulative SVR over 12 weeks of 93% in genotypes 2 patients and 85% over 24 weeks in genotype 3 patients, while delivering even higher SVRs on treatment-naïve patients.

The next big thing in treating hepatitis-C
The other currently experimental therapy very likely to make it onto the FDA's desk before the midpoint of 2014 is AbbVie's (NYSE: ABBV ) direct-acting antiviral combo drug. In similar fashion to Sovaldi, this DAA-combo therapy, which includes ABT-450 from Enanta Pharmaceuticals (NASDAQ: ENTA ) , is running six confirmatory late-stage trials on various genotypes. There are, however, two primary differences between AbbVie's DAA-combo therapy and Sovaldi.

First, AbbVie's DAA-combo drug is considered a breakthrough therapy by the FDA, meaning it'll have a potentially faster review process than Sovaldi when it was trying to make it to market.

Second, AbbVie's DAA-combo treats genotype 1 patients without the use of interferon. Not only does the combo obviously deliver fewer side effects without the use of interferon, but its recent clinical results based on SVR after 12 weeks were nothing short of jaw-dropping. Following the release of its second of six late-stage trials this past week, AbbVie's combo drug produced an SVR of 96% in 12 weeks in genotype 1 patients. Understand now that genotype 1 is the most common and also most difficult strain of the virus to treat -- and it nearly eradicated it in a sizable treatment subset.

In other words, in just 31 months we've gone from a 50% response rate over 24 to 48 weeks of dosing (not SVR... just response!) in genotype 1 patients to somewhere in the 90% to 96% SVR range over a 12 week period! That is simply phenomenal!

A cure around the corner?
Given the drastic improvement in treatment quality, the next hepatitis-C battle looks like it's not going to be fought within a laboratory but in the awareness department since a good two-thirds of the projected 3.2 million people infected have no clue they have the disease.

For this I believe we're going to see the Centers for Disease Control and Prevention turn up its attempts to increase hepatitis-C testing awareness which may turn out great for medical device maker Abbott Laboratories (NYSE: ABT ) . In June, Abbott received approval from the FDA for its hepatitis-C genotype testing device, which will better help doctors determine how to treat infected patients thanks to precise genotype mapping.

It's not often that we can talk about a "cure" for a global disease, but at the rate advancements are occurring in the hepatitis-C sector, it's quite a real possibility that within a decade or two we could be talking about an eradication of the disease altogether.

Even More Premium Stock Picks

It might seem a bit crazy to you. Why would someone invest $117,238 in just one stock? For one, this is not just any run-of-the-mill stock. This company is already growing rapidly, yet is still in the early stages of revolutionizing an entire industry just like Apple, Amazon, and Google have done. Our top technology expert, Jeremy Phillips, is so convinced of this that he's entered into a legal contract requiring him to invest $117,238 in this stock. And now, we've talked him into sharing the name and details of this company for a limited time. Simplyclick here to access our special free report outlining this incredible company.

Fool contributor Sean Williams has no material interest in any companies mentioned in this article. You can follow him on CAPS under the screen name TMFUltraLong, track every pick he makes under the screen name TrackUltraLong, and check him out on Twitter, where he goes by the handle @TMFUltraLong.

The Motley Fool recommends Gilead Sciences and Vertex Pharmaceuticals. Try any of our Foolish newsletter services free for 30 days. We Fools don't all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.

Source

Obesity triggers a 'tidal wave' of cirrhosis cases

Provided by The Guardian

Robin McKie, Science Editor
The Observer, Saturday 14 December 2013 07.17 ES

Few people are aware that there is a clear link between obesity and cirrhosis. Photograph: Dominic Lipinski/PA

Doctor Jude Oben had grim news for a patient last week. The liver expert told the 60-year-old man that he had cirrhosis – for the second time in his life.

Only four years ago Oben's patient had required a liver transplant after his first bout of cirrhosis, a condition he had contracted because he was obese. "Unfortunately my patient continued to overeat and remained obese," said Oben, a hepatologist based at the Royal Free and St Thomas' hospitals in London. "As a result, he contracted cirrhosis again. Sadly, I had to tell him that this time it was very unlikely he would be given another liver."

Oben's patient is one of a "tidal wave" of cases of cirrhosis, triggered by obesity, that threatens to sweep through hospitals across the UK. "People might be aware that there are metabolic disorders such as diabetes and high blood pressure associated with obesity, but very few know about the connection with cirrhosis. However, there is a very clear link. Obesity can trigger cirrhosis."

Oben, who recently launched the charity Obesity Action Campaign to help in the battle against the spread of the condition, said that 10 years ago he saw only an occasional case of obesity-related cirrhosis in his clinic. Today he has dozens of cases of the illness, which occurs when irreversible scarring causes a person's liver to deteriorate. In the past, excess alcohol consumption and hepatitis infections have been the main causes of cirrhosis in Britain. Now a third cause – obesity – has triggered a major increase in cases of liver disease in the UK.

The average age of death from liver disease is 59, compared with 82-84 for heart and lung disease and strokes, for example. It is the fifth largest cause of death in the UK, and in the past 10 years there has been a fivefold increase in cirrhosis for those aged between 35 and 55. Oben predicts that these figures are only going to get worse as obesity levels rise.

"About a third of the UK population is now obese, while one government estimate recently suggested that this figure will rise to 50% by 2050," said Oben. "Frankly, I think we will have reached that level long before then, and when we do that we will find that cirrhosis case numbers have increased steeply."

Nor will cirrhosis cases be the only ones to follow in the wake of Britain's increasing obesity levels. Cancers of the oesophagus, liver, pancreas and colon are linked to obesity; cases of these are increasing and are expected to continue to rise.

"Frankly, we are reaching US levels of obesity," said Oben. "I went to work in the US in 2001 and was stunned by the numbers of obese people that came into clinics. When I came back to Britain a few years later, I discovered – to my horror – that we are catching up."

As to the causes of this expected tidal wave of obesity-linked illness, scientists point to the increasing abundance of calorie-dense foods and a decrease in numbers of people taking regular exercise. In addition, Oben's own research has indicated that obese mothers may pass on a propensity for their offspring to become obese.

"It is another worrying factor," he said. "Obesity is a very difficult condition to treat medically."

WATCH THAT WAIST

According to Jude Oben – who also works as a researcher at University College London – the key indication that a person is dangerously obese is not provided by their weight or by their body mass index, which is calculated by combining a person's height and weight. "You can have a high body mass index but be quite fit," he said. "In fact, the most reliable factor is simply your waist circumference."

FOR WOMEN

With waist circumferences of under 31 inches (79cm), there should be no major health problems. For those between 31 inches and 35 inches (89cm), the outlook is worrying. For those over 37 inches (94cm), the prognosis is alarming.

FOR MEN

The danger zone begins for those whose waists are greater than 37 inches, while those over 40 inches (102cm) face prospects that Oben also describes as alarming.

Obesity Action Campaign www.obesityac.org

Source

Coffee and Cigarettes May Protect Against Liver Disease

Provided by Science Daily

Liver transplantation. PSC is the main cause for liver transplantations in Scandinavia. (Credit: Ram Gupta, Oslo University Hospital)

Dec. 14, 2013 — Coffee and cigarette smoking may protect against the rare liver disease Primary Sclerosing Cholangitis (PSC), study shows.

In a new study from Norway published inClinical Gastroenterology and Hepatology, both coffee consumption and cigarette smoking are shown to potentially protect against primary sclerosing cholangitis (PSC). This is a chronic liver disease caused by chronic inflammation of the bile ducts.

The findings are of great interest against a backdrop of increasing knowledge on coffee as a possible protective agent in other liver diseases.

The cross-sectional study was conducted by researchers at the Norwegian PSC Research Center based at Oslo University Hospital and the University of Oslo.

The study was conducted using a questionnaire about environmental exposures, and included 240 PSC patients and 245 controls.

Coffee

The study shows showed that the PSC patients had lower coffee consumption both currently and in the early adulthood, suggesting that coffee consumption could protect against the development of the disease. PSC patients who drank coffee, however, had lower levels of liver enzymes in the blood, thus suggesting a beneficial effect in the liver.

Cigarettes

Regarding cigarette smoking, only 20% of the patients reported ever daily cigarette smoking, compared with 43% of the healthy controls. In addition, cigarette smokers acquired the disease on average 10 years later than non-smokers. Taken together, these observations confirm and strengthen previous observations of smoking as a possible protective factor in PSC.

About PSC

While PSC is not a common disease, it is a severe condition affecting mostly young adults (30-40 years), and with a high risk of associated cancer of the bile ducts.

Few treatment options are available and PSC is one of the most important reasons for liver transplantation. While the possible protective effect of smoking against PSC seems rather unique to this particular liver disease, coffee consumption has been shown to protect against multiple other liver conditions including liver cirrhosis and liver cancer -- and now for the first time also against PSC.

Story Source:

The above story is based on materials provided by Oslo University Hospital, via AlphaGalileo.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Source

10 Questions You Should Ask If Diagnosed with Hepatitis C

Provided by Avail Clinical Research

Being told that you have hepatitis C can be extremely difficult. Patients often grapple with a wide range of emotions following this diagnosis – from denial or anger to depression. So what’s the best thing that a person can do in this scenario? They should learn as much as they can about hepatitis C, as it’ll make it much easier to cope and to continue living life well.

A doctor will be able to explain the following upon receiving the diagnosis:

• How hepatitis will affect the patient’s everyday life
• The best contemporary treatments for hepatitis C
• Lifestyle changes that will help manage symptoms for the long-run.

This can be a stressful experience, so we suggest having some questions written down beforehand. It’s also advisable to bring a loved one to the appointment for added support. Here are ten questions you should ask your doctor following the diagnosis.

1) Which hepatitis treatments are the best for me?

There are a variety of treatments available for HCV, and you’ll want to know all the risks and benefits before taking new medication. Don’t be afraid to continue nudging your doctor for more information. You need to be confident in the fact that you fully understand what they have told you.

2) Why the blood tests?

Hepatitis C often shows no physical symptoms. Blood tests allow doctors to monitor the viral activity in your bloodstream and determine the best treatments moving forward. Also ask your doctor whether you need to be immunized against hepatitis A and B.

3) What should I do to stay healthy?

Your doctor will provide plenty of information and advice about staying healthy with hepatitis C. This disease primarily attacks the liver – thus most recommendations are designed to protect this organ. Here are a few things you’ll need to keep in mind:

• Avoiding alcohol
• Getting regular exercise
• Maintaining a healthy diet

4) What can I do to limit my risk of contracting HCV?

1 in 5 patients with acute hepatitis will recover without any treatment or therapy. Unfortunately HCV adapts so rapidly that their body will not be able to develop an immunity against it. If you no longer show any viral activity, ask your doctor about what steps you can take to limit risk of contracting HCV again.

5) What over-the-counter medication should I avoid?

Discuss all other medications that you might be taking – supplements and vitamins included. Don’t lie about your alcohol habits or any other type of drug use.Hepatitis puts your liver in great jeopardy and lying here could be fatal.

6) Where can I go for support?

Being diagnosed with hepatitis can feel isolating, but you’re not alone. There are many amazing support groups that you can be connected with. Be sure to ask your doctor for some local referrals and resources.

7) What sort of diet should I follow?

There is no diet that has been designed specifically for hepatitis. Instead patients should adopt a more balanced diet with more fruits and vegetables and low in fatty, processed foods. Ask your doctor for some advice on creating a new shopping list to get you started.

8) How do I protect my liver?

This infectious disease is the number one cause of liver transplants. So hepatitis C patients will need to remove alcohol from their lives completely. Be sure to ask you doctor about other steps you can take to protect your liver specifically.

9) Are there clinical trials that I can take part in?

Hepatitis C clinical trials are working to develop better treatments. Ask your doctor if there are any opportunities in your area. There are numerous benefits to enrolling in a clinical trial:

• Access to experimental therapies available nowhere else
• Provided expert medical care
• Compensation for your participation

10) How do I share this diagnosis with those I’m closest too?

This may be one of the hardest steps to take following such a diagnosis – as it is one of the most important. Remember that you don’t need to tell every person in your life about it, but that support of loved ones is essential. Hep C support groupscan help you make this step when you are ready.

Challenges and opportunities for an HIV cure

12 December 2013, (Geneva, Switzerland) -- Researchers from the Brigham and Women's Hospital and Harvard Medical School have recently reported that the two so-called "Boston patients" who were initially thought to have been potentially “cured” of HIV, by a bone marrow transplantation to treat their cancer, have seen their HIV virus return. These two patients had no detectable virus after the transplants, and stopped their antiretroviral drugs. Although they did well for a remarkably long time (several weeks), the virus eventually rebounded. They have now resumed standard anti-HIV treatment and are apparently doing well.

While this is disappointing from a clinical point of view, and for the two individuals concerned, these results are of high scientific interest. Further study of these patients should contribute to a better understanding of HIV reservoirs, and where and how the virus "hides" in cells.

To date, the only adult known to have completely eliminated HIV is the Berlin patient. Conversely from the two Boston patients, he received bone marrow transplant from an individual with a natural mutated form of the CCR5 receptor. This naturally occurring mutated form of the receptor renders cells resistant to HIV infection. Further studies are necessary to understand if this played a role in the different clinical outcomes.

Other recent studies that reinvigorate hope for an HIV cure include the report of patients in France who initiated treatment very rapidly after HIV infection. Following prolonged anti-retroviral treatment, this group is now able to control the viral replication, despite the absence of therapy, mimicking the rare individuals capable of spontaneously controlling HIV. Another interesting case is the ‘Mississippi baby’. In this situation treatment was given within the first 30 hours of life, and some two years later, HIV remains undetectable, even without ongoing treatment. In these two examples early treatment by limiting the size of the reservoirs seem to have been determinant in maintaining the control of the infection when antiretroviral medicines were stopped.

The latest results on the Boston patients indicate that drastic reduction of the level of HIV reservoirs may be necessary but not sufficient to achieve a state of remission of HIV infection in the absence of antiretroviral treatment. This is sobering news but science often advances in a series of steps back and forth. Setbacks such as that in Boston are common and expected, and it is critical that we learn as much as possible from these studies, and continue our progress towards an HIV cure. Researchers will need to continue to reinforce collaboration and act as a global community to increase our knowledge of HIV reservoirs, identify better ways to measure the reservoirs and pursue new directions to target cells harboring latent HIV.

The Global Scientific initiative to find an HIV Cure, led by the International AIDS Society will continue its efforts to foster collaboration globally both within the HIV research sector and beyond, in other health sectors such as cancer treatment – as there are interesting commonalities with regards to remission control. Those working within this collaborative effort are looking at all the options that could bring about an effective, sustainable and accessible cure for HIV. More information can be found at www.towardsanhivcure.org

About the IAS

The International AIDS Society (IAS) is the world's leading independent association of HIV professionals, with over 16,000 members from more than 196 countries working at all levels of the global response to AIDS. The IAS members include researchers from all disciplines, clinicians, public health and community practitioners on the frontlines of the epidemic, as well as policy and programme planners.

The IAS is custodian of the biennial International AIDS Conference, which will be held in Melbourne, Australia, 20-25 July 2014 and lead organizer of the IAS Conference on HIV Pathogenesis, Treatment and Prevention, which will be held in Vancouver, British Columbia, Canada, 19-22 July 2015. www.iasociety.org  | www.aids2014.org  | www.ias2015.org

For more information:
Sian Bowen (Geneva, Switzerland)
Senior Manager, Communications, IAS
Email: Sian.Bowen@iasociety.org
Tel: +41 22 710 0864
Mobile: +41 79 543 5880

Source

High Risk of Decompensation with Precirrhosis in HIV/HCV + People

Author: Mark Mascolini

14 December 2013

People with precirrhosis and HIV/HCV coinfection run a high risk of liver decompensation, according to results of an 892-person analysis in Spain. The researchers believe precirrhosis patients with HIV/HCV should begin immediate anti-HCV therapy.

Liver decompensation is an advanced cirrhosis stage in which the liver can no longer function normally. Understanding which patients with cirrhosis run a high risk of decompensation is critical to prioritizing therapy. A group of Spanish clinical investigators conducted this study to determine risk of decompensation in HIV/HCV-coinfected patients with fibrosis.

The study involved 892 coinfected people who had not taken anti-HCV therapy or did not have a sustained virologic response to HCV therapy. Fibrosis was staged by biopsy in 317 people (35.5%) and by liver stiffness measurement in 575 (64.5%). The researchers defined precirrhosis as a liver stiffness measurement of 9.5 to 14.5 kilopascals and cirrhosis as a measurement of 14.6 kilopascals or greater.

Among the 317 patients staged by biopsy, the probability of remaining free of decompensation was statistically similar for people with F3 versus F4 fibrosis at 1 year: 99% (95% confidence interval [CI] 95% to 100%) versus 96% (95% CI 91% to 98%). But at 3 years the probability of remaining free of decompensation was significantly greater with F3 versus F4 fibrosis: 98% (95% CI 94% to 100%) versus 87% (95% CI 81% to 92%).

Multivariate analysis identified only one factor independently associated with liver decompensation in biopsy patients: Having F4 versus F3 fibrosis doubled the risk of decompensation (subhazard ratio 2.1, 95% CI 1.07 to 4.1, P = 0.032).

Among the 575 patients staged by liver stiffness measurement, the probability of remaining free of decompensation at 1 year approached significance when comparing F3 versus F4 fibrosis: 99% (95% CI 96% to 100%) versus 93% (95% CI 89% to 96%). The difference in decompensation risk between F3 and F4 fibrosis reached significance at 3 years: 97% (95% CI 94% to 99%) versus 83% (95% CI 77% to 87%).

In people evaluated by liver stiffness measurement, having cirrhosis rather than precirrhosis independently raised the risk of decompensation more than 5 times (subhazard ratio 5.67, 95% CI 2.27 to 14.2, P < 0.0001). A platelet count below versus above 100,000 almost doubled the risk of decompensation (subhazard ratio 1.86, 95% CI 1.10 to 3.42, P = 0.046).

“As in patients with cirrhosis,” the authors maintain, “immediate therapy against HCV is warranted for patients with precirrhosis and HIV coinfection, as they are at risk of decompensation soon after the diagnosis of advanced fibrosis.”

Source: Juan Macías, Manuel Márquez, Francisco Téllez, Dolores Merino, Patricia Jiménez-Aguilar, Luis F. López-Cortés, Enrique Ortega, Miguel A. von Wichmann, Antonio Rivero, María Mancebo, Jesús Santos, Montserrat Pérez-Pérez, Ignacio Suárez-Lozano, Alberto Romero-Palacios, Almudena Torres-Cornejo, Juan A. Pineda. Risk of liver decompensation among HIV/hepatitis C virus-coinfected individuals with advanced fibrosis: implications for the timing of therapy. Clinical Infectious Diseases. 2013; 57: 1401-1408.

For the study abstract
(Downloading the complete article requires a subscription to the Clinical Infectious Diseases or an online payment; the abstract is free.)

Treating HCV Aids Patients Who Also Have Diabetes

Published: Dec 14, 2013

This report is part of a 12-month Clinical Context series.

By Cole Petrochko, Staff Writer, MedPage Today

Patients with hepatitis C and diabetes had improved cardiovascular and renal outcomes when treated with pegylated interferon plus ribavirin, researchers found.

Compared with untreated and uninfected participants, patients with hepatitis C virus (HCV) and diabetes had significantly lower cumulative 8-year incidence of end-stage renal disease (1.1% for treated, infected patients versus 9.3% for untreated patients and 3.3% for uninfected patients, P<0.001) and stroke (3.1% versus 5.3% and 6.1%, respectively, P=0.01), according to Chun-Ying Wu, MD, PhD, of the Taichung Veterans General Hospital in Taiwan, and colleagues.

There was also a trend toward less acute coronary syndrome (4.1% versus 6.6% and 7.4%, respectively, P=0.05), they wrote online in the journal Hepatology. After adjustment, antiviral treatment remained significantly associated with improved outcomes for ischemic stroke and end-stage renal disease compared with those who were untreated.

The authors noted a "complex association" between diabetes, insulin resistance, and HCV infection. "On one hand, patients with HCV infection, as compared with the general population or those with another viral hepatitis, are more likely to develop insulin resistance and [diabetes]," they wrote.

"On the other hand, insulin resistance with or without overt manifestation of [diabetes] adversely impacts the clinical outcomes in HCV-infected patients, in terms of poor response to antiviral therapy, accelerated progression of liver fibrosis, and increased risk of hepatocellular carcinoma."

The mechanism by which HCV infection can lead to insulin resistance and diabetes is not known, but "appears to involve intracellular oxidative stress, dysregulation of cytokines, inhibition of insulin downstream signaling, and reduced expression of glucose transporters," they suggested.

Although treating HCV has been shown to lower insulin resistance and thus reduce the chance of developing diabetes, it is not clear how treating HCV infection in patients who already have diabetes will affect outcomes in this group.

To explore the issue further, the researchers studied 1,411 Taiwanese patients with diabetes and HCV infection who were treated with pegylated interferon plus ribavirin. These participants were matched one-to-one with HCV-infected but untreated control patients and one-to-four with diabetic patients who were not infected with HCV.

Primary outcomes included end-stage renal disease, acute coronary syndrome, and ischemic stroke. Associations were adjusted for hypertension, dyslipidemia, chronic obstructive pulmonary disease, and peripheral arterial occlusive disease.

Follow-up occurred over a mean 3.8, 3.7, and 3.8 years for the treated, untreated, and uninfected groups, respectively, with a maximum follow-up of 8 years.

Cumulative incidence of death at 8 years was highest among untreated patients (23.6%) versus the treated (13%) and uninfected (11.4%) participants.

Treatment was associated with a hazard ratio of 0.16 (95% CI 0.07-0.33) for end-stage renal disease, and of 0.53 (95% CI 0.30-0.93) for ischemic stroke. Treatment was not significantly associated with outcomes for acute coronary syndrome.

Risks for any of the three outcomes were lowest among treated patients in a multivariate-adjusted Cox proportional hazard model.

The investigators concluded that the anti-HCV therapy's effect on diabetes may be associated with its effects "in ameliorating insulin resistance and restoring glucose homeostasis, which has been convincingly demonstrated in previous studies," and that "antiviral therapy may also improve renal and cardiovascular outcomes through other mechanisms."

They noted that their outcomes could not be extrapolated to patients with significant comorbidity, that the data collected on HCV did not include viral genotype or viral load, there were no data on adherence to medication, and there was no measure of diabetic history and other physiological confounders. Their data also may not be generalizable to a non-Taiwanese population.

The study was supported by Taiwan's National Health Research Insitute and Taiwan's National Science Council.

One co-author received support from Merck Sharp and Dohme, and Roche.

Primary source: Hepatology
Source reference: Wu CY, et al "Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients" Hepatology2013; DOI: 10.1002/hep.26892.

Source

Also See: Antivirals for HCV improve kidney and cardiovascular diseases in diabetic patients