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June 22, 2007
Non-Invasive and Inexpensive Fibrosis Evaluation for HCV
By combining standard liver blood tests with a patient’s age, French researchers have developed a reliable and inexpensive method to determine the extent of liver fibrosis in people with Hepatitis C. While the accuracy of this calculation is only valid within a narrow window of liver injury, it may save many patients from undergoing costly and invasive liver biopsies.
FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest.
Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, Fontaine H, Pol S.
www.ncbi.nlm.nih.gov
Université Paris‐Descartes, Paris, France.
To optimize the management of patients with chronic hepatitis C virus (HCV) infection, noninvasive tests to determine the degree of hepatic fibrosis have been developed. The aims of this study were (1) to validate a simple, inexpensive, noninvasive test called FIB-4, which combines standard biochemical values (platelets, ALT, AST) and age, in a series of 847 liver biopsies performed in HCV-monoinfected patients; and (2) to compare the results of 780 FIB-4 and FibroTests performed the same day in a series of 592 HCV-infected patients. The FIB-4 index enabled the correct identification of patients with severe fibrosis (F3-F4) and cirrhosis with an area under the receiver operating characteristic curve of 0.85 (95% CI 0.82-0.89) and 0.91 (95% CI 0.86-0.93), respectively. An FIB-4 index <1.45 had a negative predictive value of 94.7% to exclude severe fibrosis with a sensitivity of 74.3%. An FIB-4 index higher than 3.25 had a positive predictive value to confirm the existence of a significant fibrosis (F3-F4) of 82.1% with a specificity of 98.2%. Using these ranges, 72.8% of the 847 liver biopsies were correctly classified. The FIB-4 index was strongly correlated to the FibroTest results for a score <1.45 or >3.25 (kappa = 0.561, P < 0.01). A FIB-4 value <1.45 or >3.25 (64.6% of the cases) was concordant with FibroTest results in 92.1% and 76%, respectively. Conclusion: For values outside 1.45-3.25, the FIB-4 index is a simple, accurate, and inexpensive method for assessing liver fibrosis and proved to be concordant with FibroTest results. (HEPATOLOGY 2007.).
Posted by Editors at 10:49 AM --- Printer-friendly version
June 21, 2007
New Hepatitis C Cases Connected to NYC Anesthesiologist
According to the Department of Health and Mental Hygiene, it was recently discovered that a NYC anesthesiologist might have transmitted Hepatitis C to at least three patients. With over 4,500 other people treated by this same doctor being made aware of their potential risk of exposure, find out how common transmission of the disease is within a medical setting.
3 Hepatitis C Cases Linked to NYC Doctor
www.cfnews13.com
NEW YORK(AP)
Authorities urged 4,500 people who were treated by an anesthesiologist to get tested for hepatitis C, saying three patients may have been infected as the doctor gave them anesthesia.
The city Department of Health and Mental Hygiene said Thursday it was mailing letters to everyone at risk and noted that the liver-damaging disease cannot be spread by casual contact.
Three people treated by the doctor in August were diagnosed with hepatitis C in recent months, the health department said. Laboratory tests suggest they were infected while getting intravenous anesthesia drugs during outpatient procedures, according to the agency.
Authorities have not identified the anesthesiologist. A state Health Department spokeswoman, Claudia Hutton, said the agency had not established "that the doctor is guilty of doing anything wrong."
The doctor has had a medical license since 1977 and "does not have a history of spreading infection," Hutton said.
City authorities said they were contacting everyone treated by the anesthesiologist while he or she practiced at 10 different medical offices in New York City, from Dec. 1, 2003, to May 1, 2007. The doctor has stopped practicing during the investigation, the city health department said.
"Transmission of hepatitis in a medical setting is rare, but as a precaution we are reaching out to anyone who could have potentially been exposed," Dr. Marci Layton, the agency's assistant commissioner for communicable disease, said in a statement.
She stressed that intravenous medications are "very safe when standard infection-control procedures are followed," and that patients should not avoid important procedures because of worries about infections.
Hepatitis C is a chronic, blood-borne virus that that can cause scarring or other damage to the liver. It often does not cause noticeable symptoms, although some people experience flu-like symptoms, a yellowing of the skin and the whites of the eyes, dark urine and pale feces. It is treatable, but many people who have the disease do not even know they are infected.
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Since making headlines, the number of possible Hepatitis C cases linked to the anesthesiologist in New York has nearly doubled. The doctor, whose identity has finally been revealed, now faces a lawsuit from one of his victims.
Doctor sued in spread of hepatitis C
www.upi.com
NEW YORK, June 24 (UPI) -- Two more people have contracted hepatitis C after receiving intravenous anesthesia from a doctor in New York who is under investigation.
Dr. Brian Goldweber, 64, is accused of spreading the disease by failing to follow proper infection control protocols, The New York Post reported Sunday.
A 45-year-old woman with a prominent corporate post filed a lawsuit last week against Goldweber and three other doctors at the Manhattan practice, where she underwent a colonoscopy in 2004.
She filed her suit as "Jane Doe" due to what she called the "stigma, discrimination and embarrassment" of a hepatitis C infection, which typically affects drug addicts and the sexually promiscuous.
Another woman has notified the city Health Department after contracting hepatitis C after an outpatient procedure. That notification brings the number of possible victims to at least five, the Post said.
Posted by Editors at 02:51 PM --- Printer-friendly version
June 20, 2007
Pros and Cons of Medical Marijuana with Hepatitis C
A 2006 report demonstrated the benefits of marijuana for people undergoing interferon and/or ribavirin treatment for Hepatitis C. On the other hand, recent studies have shown the use of marijuana may increase the acceleration of the disease process and possibly cause decreased immune function. The information presented in this article is not intended to encourage or discourage illegal activity, but rather to provide the reader with proven facts about marijuana's impact on the liver.
by Nicole Cutler, L.Ac.
Despite its illegality in most cases, Cannabis Sativa, commonly known as marijuana, remains a popular recreational drug throughout the world. Now, an increasing amount of proposed legislation is seeking to maintain the legality of medical marijuana, allowing for people with certain medical ailments to legally continue using this illicit drug. As of May 2007, 11 U.S. states host medical marijuana programs that allow for the chronically ill and their caregivers to possess and use marijuana for pain relief or other therapeutic purposes.
Pros
The basis of any argument in favor of medical marijuana claims that it can relieve pain, reduce nausea, and increase appetite in those with chronic disease. While illnesses such as cancer and HIV are approved for some medical marijuana legislation, Hepatitis C has been largely ignored. However, a 2006 report demonstrated a positive use of marijuana for people with HCV.
While therapy for chronic Hepatitis C is most often based on interferon medication, its value is limited due to the uncomfortable side effects it can induce, such as flu-like symptoms, fatigue, insomnia, loss of appetite, nausea, muscle and joint pain, and depression. These symptoms often lead to interferon therapy’s poor adherence, which manifests either in a dose reduction or discontinuation of treatment—both of which hinder interferon’s potential effectiveness against HCV.
Published in the October 2006 European Journal of Gastroenterology and Hepatology, a Northern California study involving 71 participants demonstrated that moderate marijuana use may relieve interferon’s side effects, helping people with Hepatitis C stick with the full treatment regimen.
Without any evidence of killing the virus, researchers assume that marijuana’s influence on Hepatitis C is due to side effect management, rather than an antiviral effect. Lead researcher, Diana Sylvestre, MD, of the University of California at San Francisco emphasized that the benefit of marijuana was primarily due to improved ability to stay on adequate doses of interferon and/or ribavirin. Sylvestre told HIVandHepatitis.com that the researchers could not judge whether marijuana had a direct antiviral effect.
Unfortunately for heavy users, this study did not examine a direct dose-response relationship between the amount of marijuana consumed and the likelihood of successful interferon therapy. In fact, participants who used the largest amounts of marijuana had less success with Hepatitis C interferon therapy. Because the researchers did not perform pre and post-treatment histological assessments using paired liver biopsies, and did not measure immune parameters, the claim of marijuana’s value in Hepatitis C therapy remains limited.
Cons
Ever since the results of the 2006 California study were published, experts have been expressing concern about the health implications of Hepatitis C patients using marijuana. A French study of untreated individuals with Hepatitis C (those not taking interferon therapies) showed that, compared with occasional or non-users of the drug, people who used marijuana daily were:
· more likely to have severe liver fibrosis
· at a higher risk for rapid fibrosis progression.
At the 2007 42nd Annual Meeting of the European Association for the Study of the Liver in Barcelona, Spain, the same French research team reported on a study linking marijuana use and liver steatosis. These researchers noted that marijuana binds to two receptors, CB1 and CB2. Recent experimental data suggests that activation of CB1 receptors increases steatogenesis (liver fat accumulation). Stimulation of the CB1 receptor is assumed to be the reason daily marijuana smoking is associated with the development of significant hepatic fibrosis.
In addition to the discovery that smoking marijuana accelerates liver fibrosis, concerns remain about its impact on the immune system. Experts explain that the use of marijuana may suppress immune function. Cannabinoid receptors are confirmed to be present on the surface of immune cells, and when the cannabinoid molecules from marijuana bind to these receptors, the person’s resistance to disease is compromised. Therefore, various studies have concluded that using marijuana can enhance the disease process.
To Use or Not to Use
While the decision to use marijuana with Hepatitis C is highly personal, taking these facts into consideration can help clarify its proven impact on those living with this disease. In particular, advocates suggest that medical marijuana laws and programs who specify its use for patients with specific conditions such as AIDS and cancer should also include people with Hepatitis C. Additionally, if you have Hepatitis C and are currently struggling with side effects of interferon therapy, it may be worth your while to investigate medical marijuana use in your area. Whether it’s breaking the law or not, any person with Hepatitis C considering smoking this drug should be aware that marijuana has been linked with increased liver fibrosis and possibly with decreased immune function. Whatever you choose to do, make your decisions based on what you believe will enhance your odds at fighting the infectious virus, not on what will hamper them.
References:
Cabral GA, et al., Effects on the Immune System, Handbook of Experimental Pharmacology, 2005.
Klein, TW, et al., Marijuana, immunity and infection, Journal of Neuroimmunology, March 1998.
www.boston.com, Senate votes to allow medical marijuana permanently, Ray Henry, The New York Times Company, May 2007.
www.hivandhepatitis.com, Cannabis Use Predicts Severe Liver Steatosis in Patients with Chronic Hepatitis C, Liz Highleyman, hivandhepatitis.com, 2007.
www.hivandhepatitis.com, Moderate Cannabis Use Associated with Improved Treatment Response in Hepatitis C Patients on Methadone, Liz Highleyman, hivandhepatitis.com, 2007.
www.medscape.com, Hepatitis C -- Current State of the Art and Future Directions, David Bernstein, MD, Medscape, 2007.
www.natap.org, Daily Cannabis Smoking as a Risk Factor for Fibrosis Progression in Chronic Hepatitis C, natap.org, 2007.
www.washingtonpost.com, Marijuana Aids Therapy, Rick Weiss, washingtonpost.com, September 2006.
Posted by Editors at 12:55 PM --- Printer-friendly version