Research & Treatment News
March 29, 2007
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Studies show that up to one in ten mothers infected with the Hepatitis C virus are likely to transmit the infectious disease to their children. Learn how much the risk of transmission increases when the mother is also infected with HIV.
Derek Thaczuk, Thursday, March 29, 2007
http://www.aidsmap.com
A new meta-analysis has confirmed that the mother-to-child transmission risk for hepatitis C virus (HCV) nearly doubles for mothers who are HCV/HIV coinfected. In coinfected mothers with detectable HCV viremia, the risk is nearly tripled. The results, published in the April 15th issue of Clinical Infectious Diseases, confirm those of a 2003 meta-analysis by another researcher.
Rates of vertical (mother-to-child) transmission of HCV range from 4 to 10%; mothers coinfected with HIV are more likely to transmit HCV to their child. An earlier meta-analysis (Pappalardo, 2003) determined the odds ratios for HIV-coinfected compared to HIV-negative mothers as 2.82 (95% CI, 1.78 to 4.45, p=.00001) for HCV antibody-positive women, and 1.97 (95% CI, 1.04 to 3.74, p=.04) for women with HCV viremia (detectable HCV in the blood).
Researchers from Johns Hopkins University School of Medicine have now performed a similar meta-analysis including two large studies not published at the time of the Pappalardo review. One of these – the European Pediatric Hepatitis C Virus Network (EPHN) study – is the largest such cohort to date, including 1479 babies.
The team’s conclusions were drawn from a restricted analysis that they believed provided the most reliable estimate (details below). According to this analysis, vertical transmission was 1.9 times more likely for HIV/HCV coinfected mothers than for HCV-infected mothers without HIV (95% confidence interval, 1.36–2.67). For coinfected mothers with detectable HCV viremia, the risk was 2.82-fold greater (95% CI, 1.17 to 6.81) than for HIV-negative mothers without HCV viremia.
Much of the Johns Hopkins report details the methodology of how studies were selected for the meta-analysis. The original literature review found 243 “potentially relevant” published articles (conference abstracts were not considered). From these, the team selected only results published in English which (among other criteria) presented original data, compared coinfected with HCV-monoinfected women, and included at least 20 coinfected women. This left only ten (mostly European) studies, published between 1993 and 2005 (Lam, 1993; Zanetti, 1995; Paccagnini, 1995; Zuccotti, 1995; Tovo, 1997; Zanetti, 1998; Granovsky, 1998; Resti, 2002; Rerrero, 2003; EPHN, 2005). All but one of these were prospective cohorts, yielding a total of 4424 mother/child pairs, 19.4% of which included coinfected mothers.
However, the investigators felt that the “most reliable estimate” came from an even more restricted pool – the five studies with sample sizes of at least 50. The odds ratio for coinfected mothers, calculated from the ten originally selected studies, was 2.75 (95% CI, 1.51 to 4.99). However, analysis indicated that the estimates in this group were “heterogeneous and ideally should not be pooled”. The lack of comparability was ascribed to “a lack of standardised HCV diagnostic criteria and the inability to control for known confounders” – such as selection bias, loss to follow-up, and means of delivery (Caesarean vs. live birth). The researchers therefore analysed various subgroups of the ten studies, leading to the 1.9-fold odds ratio drawn from the five studies (Paccagnini, Tovo, Granovsky, Resti, and EPHN) which “showed low heterogeneity, and were of better overall quality.”
Despite the similarity to the 2003 findings, the report concludes that more research is still required, particularly calling for “large studies that control for potential known confounders, use clear selection criteria … and employ standardized HCV testing[.]”
References
Polis CB et al. Impact of maternal HIV coinfection on the vertical transmission of hepatitis C virus: a meta-analysis. Clin Inf Dis 44:1123-1131, 2007.
Pappalardo BL. Influence of maternal human immunodeficiency virus (HIV) co-infection on vertical transmission of hepatitis C virus (HCV): a meta-analysis. Int J Epidemiol 32:727-734, 2003.
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Eighty-five percent of HCV patients develop chronic Hepatitis C. The remaining 15 percent have acute Hepatitis C, which spontaneously resolves within weeks or months. Learn how the health of your immune system determines whether the virus progresses to advanced liver disease and what you can do to help support your immune system.
by Nicole Cutler, L.Ac.
Our defense against bacteria and viruses, the immune system is essential in maintaining health. The strength of our immune system is one factor that determines whether Hepatitis C becomes of an acute case or develops into a chronic illness.
Hepatitis C’s extraordinary ability to evade the body’s immune system has been the focus of countless medical studies. Researchers at Johns Hopkins University School of Medicine have discovered how the genetic changes resulting from Hepatitis C infection allow it to avoid destruction by the body’s immune system.
Two Ways, Two Sites
Scientists have found that HCV is programmed to change form in two different ways, at two different sites. The genetic material under attack by immune cells evolves to weaken the immune system, while genetic material at different sites reverts back to an ancestral, or original, genetic code. This dual morphing capability of the Hepatitis C virus is why it is so challenging for the immune system to destroy. The infection becomes chronic when the virus evades immune cells and establishes itself in the body. At this point, the immune system becomes weakened and ineffective against Hepatitis C. For the millions of people in this position, their best defense against progression of the disease is by supporting and strengthening their immunity.
According to Hopkins study investigator, associate professor and infectious disease specialist, Stuart Ray, MD, "We think this piecemeal exchange is helping the virus evade the body's immune system. In a newly infected person, the virus may need to adopt new mutations to escape recognition by the immune system's T cells, which fight infection, but it may need to lose the mutations that had protected it in someone else. Despite pressure to change, the virus is always restoring its shape."
Ancestral Genetic Sequence
Hepatitis C demonstrates amazing self-modification capability. When the danger dissipates, the virus returns to its original form. The Johns Hopkins investigators found that when the immune response weakened, the Hepatitis C virus naturally mutated back to its preferred state. During the acute phase of infection, the virus is under severe pressure from the body’s immune response, forcing it to mutate. However, this change appears to be reversible. Once the virus successfully evades a particular immune cell, its amino acids revert back to its original sequence.
Fast Reproduction
According to the lead author of one of the studies, assistant professor at Hopkins and infectious disease specialist, Andrea Cox, MD, PhD, “The Hepatitis C virus naturally mutates, or alters its genome, very rapidly. For example, its strains have two to three times more genetic variability than HIV, the virus that causes AIDS, and Hepatitis C reproduces over 100 billion times per day, 100 times faster than HIV. Compounding the problem, Hepatitis C infection is asymptomatic in the early stages, making it less likely that diagnosis will be made early, when it is easiest to treat.” The speed at which Hepatitis C is capable of reproducing poses an additional challenge to stopping the virus dead in its tracks.
Darwin’s Prodigy
Charles Darwin, the father of evolution comprehension, put forth the concept that the Hepatitis C virus closely follows. The well-known phrase, “survival of the fittest,” is applicable to this virus’ lifecycle. The Hepatitis C virus' genetic material changes in ways that make it more reproductively "fit" in the face of each immune system it encounters. The virus changes to evade the immune system in one host, then restores itself when the pressure is off.
Good News
The silver lining in discovering Hepatitis C’s mastery of transformation is the insight it provides researchers working to defeat the virus. In response to this research, scientists have identified Hepatitis C’s chain of amino acids, its ancestral genetic code. Having this code is a critical to genetic biologists in developing a potential vaccine.
Maintaining strong immunity means paying attention to your body and incorporating healthful lifestyle choices into your routine. In general, experts recommend the following tips for a healthy immune system:
· Get Sufficient Sleep – The immune system is replenished during the deep stages of sleep.
· Wash Your Hands – Keeping your hands clean will reduce stress on the immune system by minimizing the microbes it must constantly battle.
· Follow a Balanced, Nutritious Diet – Eating well provides your immune system with the tools it needs to be in tip-top shape. Avoid sugar and the processed foods that harm immunity by suppressing crucial immune cells. If need be, consult a nutritionist for proper guidance.
· Avoid Toxins – Items toxic to your immune system include alcohol, cigarettes, chemicals and pollution. Toxins slow down and weaken the immune response. Consider an antioxidant and natural detoxifier such as Liv.52 to neutralize the toxins you encounter every day.
· Reduce Stress – Finding ways to minimize stress reduces stress-related hormones from weakening the immune system.
· Supplement – Consider supplementing your diet with a safe, energy enhancement solution product such as Fatigue Relief Plus. In addition to naturally replenishing energy to overcome the fatigue associated with HCV, it provides vitamins, minerals and probiotics to strengthen the body’s immune system.
Keeping your immune system as strong as possible is the key to longevity. Whether you are virus-free or not, fortifying your defenses can make the difference between developing acute or chronic viral hepatitis, as well as preventing liver disease progression.
References:
Gremion C, Cerny A, Hepatitis C Virus and the Immune System: A Concise Review, Reviews in Medical Virology, July/August 2005.
www.businessweek.com, Waging War on Hepatitis C, John Carey, McGraw Hill Companies, February, 2006.
www.hcvadvocate.org, The Role of the Immune System in Determining Viral Outcome After Hepatitis C Viral Infection, Jose Azocar, MD, DS, Hepatitis C Support Project, 2006.
www.medicinenet.com, Hepatitis C, MedicineNet, Inc., 2006.
www.medicalnewstoday.com, How Hepatitis C Virus Evades Immune System in Acute and Chronic Infections, Johns Hopkins Medical Institutions, June 2005.
www.sciencedaily.com, Study Details Hepatitis C Ability to Block Immune System Response, Scripps Research Institute, May 2006.
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March 28, 2007
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A new drug called Infergen is opening new doors for people infected with the Hepatitis C virus who are not responding to standard treatment. Learn why this treatment option is recommended for non-responders, and other key information to share with your physician in determining whether Infergen may be right for you.
Help for Hep C
By Margot Kim
http://abclocal.go.com
Nearly 4 million Americans are living with hepatitis C, and more than a quarter million of them have failed standard treatment options. Now, a newer, tougher drug is curing the virus in more people.
For six years, Louise Overman has battled hepatitis C -- a virus that killed the only two people she ever knew who had it. “To clear the hepatitis C was paramount to me,” she says. Her first treatment -- a yearlong ordeal -- didn't work. Her second treatment also fell short, but her goal has remained unchanged.
“Cure it. Kill the monster.”
Hepatologist Mitchell Shiffman, M.D., says that's a tough job, but it's possible. “It is the only virus that we are aware of that can actually be cured. It can be completely eradicated from the body,” he tells Ivanhoe.
But less than half of people with the most common type of hepatitis C are cured. Now, a drug called Infergen is changing the future for patients who fail standard treatment.
“Re-treatment with Infergen at a daily dose can render an additional 25 percent of these resistant patients’ virus undetectable,” Dr. Shiffman of Virginia Commonwealth University in Richmond, says. Drugs called interferons are commonly used to fight hepatitis C. Infergen is a highly potent interferon that is injected once a day for one year.
Dr. Shiffman says Infergen is FDA-approved and would likely be offered to patients who have failed previous treatments rather than given as a first treatment. That's because Infergen needs to be taken every day as opposed to once a week with other interferons.
Despite failing two different treatments, Shiffman was ready for round three. She was right. After just three months on Infergen, her virus was gone.
“That's just wonderful news. That is really amazing,” Overman says. And she says it's a relief to finally put her six-year battle behind her and get on with her life.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/.
If you would like more information, please contact:
Virginia Commonwealth University Health System
Physician Referrals
(800) 762-6161
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March 26, 2007
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According to the Centers for Disease Control and Prevention (CDC), vaccination programs for Hepatitis A and B have helped decrease the rate for new acute hepatitis infections. Despite this good news, the American Liver Foundation (ALF) points out that chronic Hepatitis C infection rates have not followed suit and are actually increasing. Learn what is causing the concern behind the ALF's response, and how the cost of treating Hepatitis C impacts our health care system.
http://sev.prnewswire.com
The American Liver Foundation Urges Cautious Optimism about CDC Report on Declining Acute Hepatitis Infection Rates
Focus Must Remain on the Millions Still Suffering from Chronic Hepatitis B and C
NEW YORK, March 21 /PRNewswire/ -- The Centers for Disease Control and Prevention (CDC) has reported that significant decline in the rates of new acute hepatitis infections in the United States in the last 10 years, reflecting the success of hepatitis A and B vaccination programs. The American Liver Foundation wants to highlight these positive results, but remind people that chronic hepatitis B and C are very serious diseases that affect over five million Americans and that the prevalence of chronic hepatitis C infection is actually increasing. This is in response to the article "Surveillance for Acute Viral Hepatitis -- United States, 2005," published by the CDC in their publication Morbidity and Mortality Weekly Report.
Acute, or short-term, infections are more common with hepatitis A and B and less likely to cause serious health problems than a chronic, or long-term, infection. Hepatitis A does not cause chronic infections. Only five percent of all adults infected with hepatitis B develop chronic infection, although 90 percent of infants infected with hepatitis B do develop chronic hepatitis B. On the other hand, hepatitis C becomes a chronic infection for 70-80% percent of those exposed to the virus.
"I was very pleased to read this report about the decline in acute hepatitis infections," said Dr. James Boyer, Chair of the Board of the American Liver Foundation and Director of the Liver Center at the Yale University Medical School. "But this good news must not let us forget the millions of Americans suffering with chronic hepatitis. Without diagnosis and treatment these people are in serious risk of developing cirrhosis and liver cancer. Much more work needs to be done to combat hepatitis in this country."
With nearly two percent of Americans infected with the hepatitis C virus, the costs of this disease to the health care system is severe. A study conducted in 2002 estimated total medical expenditures for people with hepatitis C at $15 billion per year. The projected direct and indirect costs of hepatitis C, if infection rates do not continue to drop significantly, will be $85 billion for the years 2010-2019 as the number of people chronically infected will continue to increase.
Facts about hepatitis
* There are five distinct types of hepatitis: A, B, C, D, and E. All
cause inflammation of the liver
* The hepatitis B virus is 100 times more infectious than HIV
* It is estimated that there are 1.4 million Americans with chronic
hepatitis B
* Hepatitis B and C can lead to liver cancer
* There are vaccines for hepatitis A and B. There is no vaccine for
hepatitis C
* Hepatitis C is the most common blood-borne infection in the United
States
* Almost 4 million Americans, or 1.8 percent of the U.S. population, are
or have been infected with hepatitis C
* Recent studies suggest that approximately 40 percent of the 2.2 million
people in America's prison system are infected with hepatitis C
About the American Liver Foundation
The American Liver Foundation is the nation's leading nonprofit organization promoting liver health and disease prevention. ALF provides research, education and advocacy for those affected by liver-related diseases including hepatitis. Please visit the American Liver Foundation's Web site at http://www.liverfoundation.org/
Website: http://www.liverfoundation.org/
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