Diminishing Use of Liver Biopsy among Liver Transplant Recipients for Hepatitis C.

Background and Aims: Hepatitis C virus (HCV) cirrhosis is the leading indication for liver transplantation in the United States and recurrent HCV following liver transplantation is a major cause of allograft loss and mortality. Liver biopsies are commonly used to identify recurrent HCV and determine the need for antiviral therapy. The introduction of direct-acting antiviral agents (DAAs) has changed the management of recurrent HCV infection. This study aimed to describe the role of liver biopsies in liver transplant recipients with HCV after the introduction of DAAs. Methods: A retrospective analysis was performed looking at the rate of liver biopsies post-liver transplantation for HCV. The analysis included 475 adult liver transplants for hepatitis C performed at the University of California, Los Angeles from January 1, 2006 to October 1, 2015. Patients were divided into two eras, pre- and post-introduction of DAAs on December 1, 2013. Results: In the era before the introduction of DAAs, the percentage of patients biopsied was significantly higher compared to the era after the introduction of DAAs (56.1% vs. 26.9%, p < 0.001). Conclusions: The introduction of DAAs has changed the management of liver biopsy following liver transplantation and the management of recurrent HCV. Given that DAAs are well tolerated and have high efficacy, liver biopsies are no longer routinely used to justify the use antiviral therapy following liver transplantation

Impact Of Hepatitis C Co-Infection On CD4 Cell Count In HIV Infected Subjects

Background: Human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) co-infection is reported to be common among HIV infected subjects due to share routes of transmission. The fact that HCV infection may act as cofactor for HIV disease progression has been suggested.\ud Objective: To determine if HCV and HIV co-infection affect the immunocompetence (CD4) of the infected subjects and response to Highly Active Anti Retroviral therapy.\ud Subjects and methods: Fifty HIV/HCV co-infected and fifty HIV monoinfected adults were retrospectively studied. Their baseline CD4 cell counts were done using Dynal beads technique before commencement of HAART and repeated after six months.\ud Results: The CD4 cell counts of co-infected subjects were lower than the mono-infected subjects. Sixty eight percent of the co-infected subjects had CD4 cell count less than 200cells/uL, and they responded poorly to HAART therapy than the mono-infected subjects (P<0.05). Those with CD4 cell count greater than 200cells/uL responded better to treatment than those with CD4 cell count less than 200cells/uL (P<0.001)\ud Conclusion: HCV/HIV co-infection affects the immunocompetence of the patients and HCV may acts as cofactor for HIV disease progression. It is needful to screen all HIV positive subjects for HCV antibody as this will improve their clinical management and outcome

Timing for treatment of HCV recurrence after liver transplantation: the earlier the better.

HCV is the leading cause of death from liver disease and is the most common indication for a liver transplantation. Although HCV is a widespread health problem, disease management is particularly challenging in several key subpopulations, including liver transplant recipients. HCV recurrence after liver transplantation constituted a major challenge for the physicians during the last years. The recommended standard of care before the advent of new regimen was the treatment of confirmed recurrent disease, based either on persistent, unexplained elevated alanine aminotransferase levels or on histologically confirmed fibrosis, once rejection, biliary obstruction, and vascular damage have been ruled out. Moreover, early therapy (including interferon) has been associated with high rates of adverse effects, an increased risk of graft rejection, and higher proportions of patients requiring dose reductions. We are now facing a "new era" of direct antiviral agents that is already changing the approach to HCV burden in the post liver transplantation setting. Available data on treatment of HCV recurrence with the new antiviral drugs showed sustained virological response that ranges between 60 to 100%. In this comment we have focused on both the utility of non invasive test to evaluate the fibrosis progression and on timing of antiviral therapy for HCV recurrence. This article is protected by copyright. All rights reserved

The management of patients positive to hepatitis C virus antibody in Malta

Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease and hepatocellular carcinoma worldwide and is an important public health concern. A retrospective analysis of the demographics and management of patients who had a positive anti-HCV detected by enzyme immunoassay test done at Mater Dei Hospital was carried out to analyse the epidemiology of HCV infection in Malta and assess our management when compared to the European Association for the Study of the Liver (EASL) guidelines. 72% of patients were male. The majority of patients were aged 21-50 years. The main mode of infection was via intravenous drugs use, accounting for 68% of cases. Only 56% of patients found to be HCV Ab positive had a scheduled appointment with an infectious diseases specialist or gastroenterologist documented on the MDH online appointment system. 58% of patients had HCV RNA testing done and 45% had genotype testing. 7.3% with HCV infection were given treatment, of which 43% had a Sustained Virological Response (SVR).peer-reviewe

Alpha-fetoprotein detection of hepatocellular carcinoma leads to a standardized analysis of dynamic AFP to improve screening based detection

Detection of hepatocellular carcinoma (HCC) through screening can improve outcomes. However, HCC surveillance remains costly, cumbersome and suboptimal. We tested whether and how serum Alpha-Fetoprotein (AFP) should be used in HCC surveillance. Record linkage, dedicated pathways for management and AFP data-storage identified i) consecutive highly characterised cases of HCC diagnosed in 2009–14 and ii) a cohort of ongoing HCC-free patients undergoing regular HCC surveillance from 2009. These two well-defined Scottish patient cohorts enabled us to test the utility of AFP surveillance. Of 304 cases of HCC diagnosed over 6 years, 42% (129) were identified by a dedicated HCC surveillance programme. Of these 129, 47% (61) had a detectable lesion first identified by screening ultrasound (US) but 38% (49) were prompted by elevated AFP. Despite pre-HCC diagnosis AFP &gt;20kU/L being associated with poor outcome, ‘AFP-detected’ tumours were offered potentially curative management as frequently as ‘US-detected’ HCCs; and had comparable survival. Linearity of serial log10-transformed AFPs in HCC cases and in the screening ‘HCC-free’ cohort (n = 1509) provided indicators of high-risk AFP behaviour in HCC cases. An algorithm was devised in static mode, then tested dynamically. A case/control series in hepatitis C related disease demonstrated highly significant detection (p&lt;1.72*10−5) of patients at high risk of developing HCC. These data support the use of AFP in HCC surveillance. We show proof-of-principle that an automated and further refine-able algorithmic interpretation of AFP can identify patients at higher risk of HCC. This approach could provide a cost-effective, user-friendly and much needed addition to US surveillance

Hepatitis C virus pharmacogenomics in Latin American populations: implications in the era of direct-acting antivirals

In recent years, great progress has been made in the field of new therapeutic options for hepatitis C virus (HCV) infection. The new direct-acting antiviral agents (DAAs) represent a great hope for millions of chronically infected individuals because their use may lead to excellent cure rates with fewer side effects. In Latin America, the high prevalence of HCV genotype 1 infection and the significant association of Native American ancestry with risk predictive single-nucleotide polymorphisms (SNPs) in IFNL4 and ITPA genes highlight the need to implement new treatment regimens in these populations. However, the universal accessibility to DAAs is still not a reality in the region as their high cost is one of the major, although not the only, limiting factors for their broad implementation. Therefore, under these circumstances, could the assessment of host genetic markers be a useful tool to prioritize DAA treatment until global access to these new drugs can be achieved? This review will summarize the scientific evidences and the potential implications of HCV pharmacogenomics in this rapidly evolving era of anti-HCV drug development.Fil: Trinks, Julieta. Hospital Italiano. Instituto de Ciencias Básicas y Medicina Experimental; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Caputo, Mariela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Servicio de Huellas Digitales Genéticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Hulaniuk, María L.. Hospital Italiano. Instituto de Ciencias Básicas y Medicina Experimental; ArgentinaFil: Corach, Daniel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Servicio de Huellas Digitales Genéticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Flichman, Diego Martin. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

A new paradigm evaluating cost per cure of HCV infection in the UK

Background: New interferon (IFN)-free treatments for hepatitis C are more effective, safer but more expensive than current IFN-based therapies. Comparative data of these, versus current first generation protease inhibitors (PI) with regard to costs and treatment outcomes are needed. We investigated the real-world effectiveness, safety and cost per cure of 1st generation PI-based therapies in the UK. Methods: Medical records review of patients within the HCV Research UK database. Patients had received treatment with telaprevir or boceprevir and pegylated interferon and ribavirin (PR). Data on treatment outcome, healthcare utilisation and adverse events (AEs) requiring intervention were collected and analysed overall and by subgroups. Costs of visits, tests, therapies, adverse events and hospitalisations were estimated at the patient level. Total cost per cure was calculated as total median cost divided by SVR rate. Results: 154 patients from 35 centres were analysed. Overall median total cost per cure was £44,852 (subgroup range,: £35,492 to £107,288). Total treatment costs were accounted for by PI: 68.3 %, PR: 26.3 %, AE management: 5.4 %. Overall SVR was 62.3 % (range 25 % to 86.2 %). 36 % of patients experienced treatment-related AEs requiring intervention, 10 % required treatment-related hospitalisation. Conclusions: This is the first UK multicentre study of outcomes and costs of PI-based HCV treatments in clinical practice. There was substantial variation in total cost per cure among patient subgroups and high rates of treatment-related discontinuations, AEs and hospitalisations. Real world safety, effectiveness and total cost per cure for the new IFN free combinations should be compared against this baseline

Living with Hepatitis C: A Vermont Needs Assessment

Background: Hepatitis C (HCV) Viral infection of the liver spread primarily via blood-to-blood contact (e.g., intravenous drug use (IVDU)) United States: 3.2 million chronic HCV infections (2010) Vermont: 1.63 cases per 1000 people (2012-2013) Barriers to Care Exclusion of current IV drug users from HCV treatment programs despite their high rates of infection Lack of support, causing decreased treatment adherence Poor access to treatment: cost, transportation, competing priorities of housing, addiction management, and food HIV and HCV Research has shown that the multidisciplinary and integrated HIV model is appropriate for HCV Vermont CARES Non-profit organization that provides comprehensive services to clients with HIV in Vermonthttps://scholarworks.uvm.edu/comphp_gallery/1219/thumbnail.jp

Functional evaluation of hepatic parenchyma with dynamic tests (Indocyanine green and Hippurate ratio) in patients with HCC

Our aim was to assess hepatic functionality in patients with HCC and candidate for liver resection. We used dynamic tests of liver functionality Indocyanine green (ICG) and Hippurate ratio, for the evaluation of surgical risk and postoperative clinical course. The clinical and predictive value of the tests has been compared with each other and with routine tests. Tests have been performed on 11 patients with HCC, in 8 before surgery and after 6 months, in 1 before TACE and after 6 months. The results showed a significative correlation with the endpoints: survival, liver failure, general condition of the patients, and parallelism in the clinical assessment of patients. ICG and Hippurate ratio are useful in patients undergoing liver resection and in the follow up