Research & Treatment News
January 24, 2012
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In opposition to what seems logical, research demonstrates that becoming anemic while on Hepatitis C therapy is not such a bad thing.
by Nicole Cutler, L.Ac.
Hepatitis C treatment rests on the medications pegylated interferon and ribavirin, a combo known to cause anemia. Side effects from this traditional Hepatitis C-fighting duo are often blamed for patients discontinuing therapy and thus being unsuccessful in eliminating the virus from their body. However, researchers claim that anemia, one of the most common Hepatitis C drug side effects, may actually be a good indication that treatment will be successful.
Up until recently, standard therapy for this virus only consisted of pegylated interferon and ribavirin - a combination that was about 50 percent effective in people with the most common Hepatitis C strain: genotype 1. Although likely to dramatically boost the Hepatitis C cure rate, the latest addition of two new drugs to the Hepatitis C arsenal have not been available long enough to reliably quote how effective they are. Nonetheless, the new drugs (Incivek or Victrelis) still must be given in conjunction with pegylated interferon and ribavirin. Thus, anemia from Hepatitis C treatment remains a prominent concern.
About Anemia
Anemia develops from abnormally low levels of red blood cells or hemoglobin. Severe anemia means that a person's blood cannot carry enough oxygen to meet the needs of the body's tissues. Although other substances in the body carry oxygen to the body's tissues, hemoglobin can carry four times as much oxygen throughout the body than water or plasma.
The normal, average life span of a red blood cell is 90 to 120 days. After red blood cells have worn out, the spleen removes them from circulation. To replace those that have been removed, new red blood cells are produced in the bone marrow. Having a healthy amount of oxygen-carrying hemoglobin is a balancing act between making new red blood cells and replacing destroyed red blood cells. When this balance is thrown off kilter, a person can develop anemia.
Anemia from Hepatitis C Drugs
At least 20 percent of people treated with pegylated interferon and ribavirin get drug-induced anemia. The reason is twofold:
1. Ribavirin causes a dosage-dependent, hemolytic anemia, where red blood cells are destroyed faster than the body can make enough new ones to replace them.
2. Interferon can exacerbate anemia by suppressing the bone marrow's production of new red blood cells.
Anemia is one of the most clinically significant side effects of Hepatitis C therapy. Symptoms of anemia include:
• Shortness of breath
• Fatigue
• Pale skin color
• Chills
• Rapid heart rate
• Depression
• Reduced quality of life
If not carefully monitored and treated, hemolytic anemia can lead to jaundice, dark urine, an enlarged spleen and, in severe cases, a heart attack. Because this side effect can be severe, there is a regime for handling anemia while on Hepatitis C treatment. In general, the first approach is to reduce ribavirin dosage. If that is insufficient, an erythropoiesis-stimulating agent (ESA) like Procrit or Epogen is given to boost red blood cell production.
Anemia Is a Good Thing
Between the fear of becoming anemic on treatment, experiencing its discomfort or being skeptical of reducing ribavirin dosage or adding another drug to their regimen, most people on Hepatitis C drugs don't welcome anemia. However, data published in the November 2010 issue of the journal Gastroenterology ought to change that sentiment. According to researchers, Hepatitis C patients who develop anemia during treatment with pegylated interferon plus ribavirin are more likely to achieve a sustained virological response - the elimination of the virus from their body - than those who don't become anemic on the drugs.
Upon analyzing over 3,000 people being treated for Hepatitis C with pegylated interferon and ribavirin, Mark Sulkowski and colleagues found this to be true even when ribavirin reduction or ESA administration was given to reduce anemia. In fact, the rates of achieving a sustained virological response were greater as the severity of the anemia increased.
Because the standard duo of Hepatitis C drugs appears to be more effective in patients who incur anemia as a side effect, plummeting hemoglobin levels doesn't seem so dreadful. Especially since reducing ribavirin dosage or taking an ESA doesn't negatively impact treatment success, there is even more motivation to go on these drugs, be carefully monitored by a physician and complete the prescribed Hepatitis C drug treatment regimen.
References:
http://www.gastrojournal.org/article/S0016-5085%2810%2901222-9/abstract,
Hepatitis C Virus Treatment-Related Anemia Is Associated With Higher Sustained Virologic Response Rate, Mark S. Sulkowski, et al, Retrieved August 7, 2011, Gastroenterology, November 2010.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/SEM_anemia_08.pdf, HCV Treatment Side Effect Management: Hemolytic Anemia, Alan Franciscus, Retrieved August 7, 2011, Hepatitis C Support Project, 2011.
http://www.hepatitis.va.gov/provider/reviews/treatment-side-effects.asp#SanemiaX, Interferon and Ribavirin Treatment Side Effects, Retrieved August 7, 2011, United States Department of Veteran Affairs, 2011.
http://www.hepfi.org/nnac/pdf/hepc_anemia.pdf, Hepatitis C Treatment and Anemia, Retrieved August 7, 2011, Hepatitis Foundation International, 2011.
http://www.hivandhepatitis.com/hepatitis-c/hepatitis-c-topics/hcv-side-effects/447-hcv-anemia-neutropenia/568-anemia-during-hepatitis-c-treatment-predicts-sustained-response-to-pegylated-interferonribavirin, Anemia During Hepatitis C Treatment Predicts Sustained Response to Pegylated Interferon/Ribavirin, Liz Highleyman, Retrieved August 7, 2011, hivandhepatitis.com, 2011.
Posted by Editors at 12:05 PM --- Printer-friendly version
January 23, 2012
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In a recent study, over one third of previous non-responders cleared Hepatitis C with an interferon-free combo of two Bristol-Myers experimental drugs.
Bristol-Myers Hepatitis C Pills Clear Virus Without Injections
By Drew Armstrong and Robert Langreth
Jan. 19 (Bloomberg) -- Combining two experimental Bristol- Myers Squibb Co. pills cleared the hepatitis C virus in 36 percent of patients not helped by a standard treatment, in a small study testing a new approach against the liver disease.
The study is the first to suggest that difficult hepatitis C cases may be cured without using the injected drug interferon, said Anna Lok, the lead study author and director of hepatology at the University of Michigan in Ann Arbor. Interferon, a mainstay of existing treatment, causes unpleasant side effects including fatigue and flu-like symptoms.
Drug companies including Bristol-Myers, Merck & Co., Gilead Sciences Inc., and Vertex Pharmaceuticals Inc. are racing to come up with interferon-free treatment. The new results in 21 patients show that such a therapy will be possible, Lok said.
Continue reading this entire article:
http://www.businessweek.com/news/2012-01-23/bristol-myers-hepatitis-c-pills-clear-virus-without-injections.html
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Helping to explain why Hepatitis C can cause extrahepatic manifestations (problems outside of the liver), American researchers confirmed that certain brain cells are susceptible to the Hepatitis C virus.
The team of virologists found that the endothelial cells in the brain possess the four main protein receptors necessary for the blood-brain barrier to be targeted by HCV.
The findings, which are published online today in Research Highlights in the journal Nature Reviews Gastroenterology and Hepatology, show that cells other than liver hepatocytes can be vulnerable to HCV infection.
Working with the Manhattan Brain Bank in New York, USA, the researchers, led by Dr Nicola Fletcher, of the University's School of Immunity and Infection, detected HCV genomic materal in the brains of four of ten infected patients who posthumously donated brain and liver tissue.
Continue reading this entire article:
http://medicalxpress.com/news/2012-01-scientists-brain-vulnerable-hepatitis-virus.html
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January 13, 2012
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Two separate Mayo Clinic studies find that liver cancer rates are magnified by obesity and Hepatitis C infection.
Obesity, hepatitis C infection ups liver cancer risk
ANI Jan 4, 2012
Obese people and those who are infected with hepatitis C may be at high risk of developing deadly liver cancer 20 to 30 years later, according to scientists.
Two recent Mayo Clinic studies offer a clearer picture of the rise of hepatocellular carcinoma (HCC), or liver cancer, which has tripled in the U.S. in the last three decades and has a 10 to 12 per cent five-year survival rate when detected in later stages.
"The studies illuminate the importance of identifying people with risk factors in certain populations to help catch the disease in its early, treatable stages," said W. Ray Kim, M.D., a specialist in Gastroenterology and Hepatology and principal investigator of one study.
Continue reading this entire article:
http://articles.timesofindia.indiatimes.com/2012-01-04/health/30588668_1_liver-cancer-liver-scarring-hepatitis
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January 9, 2012
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By targeting the inside of a Hepatitis C viral cell for a greater T-cell response, Oxford researchers are one step closer to a vaccine for preventing Hepatitis C infection.
New vaccine for hepatitis C underway
A new vaccine for hepatitis C had been developed by a team of experts recently. The first clinical trial for testing the efficacy of the vaccine has yielded positive results, as reported by Oxford University professionals.
The vaccine was developed by a collaboration of scientists from the Oxford University, the University of Birmingham and an Italian biotech company. This team aimed to use a new avenue to instigate a distinct arm of the immune mechanism than the one used in initial studies. This injection is formulated to enable T cell responsiveness to the more consistent areas of the hepatitis C virus, instead of striking the outer coat of the virus which keeps varying persistently.
Continue reading this entire article:
http://www.healthjockey.com/2012/01/05/new-vaccine-for-hepatitis-c-underway/#
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Likely due to its convenient dosing, safety and tolerability, Achillion's ACH-1625 has been awarded fast-track status by FDA.
Achillion hepatitis drug gets faster FDA review
January 4, 2012
(AP) NEW HAVEN, Conn. -- A chronic hepatitis c treatment being developed by from Achillion Pharmaceuticals received fast track designation, allowing for a quicker review by regulators.
Achillion said Wednesday the treatment, labeled ACH-1625, is in mid-stage clinical testing. The designation allows drug developers to submit their applications to the Food and Drug Administration piece by piece instead of having to file all the paperwork at once.
It also allows for more frequent interaction with regulators and a possible priority review.
Continue reading this entire article:
http://www.cbsnews.com/8301-505245_162-57351972/achillion-hepatitis-drug-gets-faster-fda-review/
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Indicative of its compliance with Europe's standards, Roche's tests to confirm Hepatitis C infection and predict treatment response have been acknowledged by the EU.
Roche's Novel Tests for the Management of Hepatitis C Virus Infection Receive CE Mark
By: PR Newswire
Jan. 5, 2012
Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that its novel, state of the art Hepatitis C virus (HCV) qualitative and quantitative tests received CE mark. The tests detect HCV RNA, which is a crucial marker in the management of hepatitis C infection. In the new era of antiviral HCV therapies, sensitive detection and measurement of HCV RNA play an important role in determining treatment duration and predicting treatment response.
"The two tests provide a holistic solution for the management of hepatitis C infection: from the confirmation of a hepatitis C infection to the prediction and assessment of treatment response," said Paul Brown, Ph.D., Head of Roche Molecular Diagnostics. "Considering the rapidly changing hepatitis C treatment environment, we are pleased to provide two medically relevant tests on one fully automated platform. This offers clinicians the tools to manage their patients effectively and laboratories the automation and flexibility to maximize their workflow efficiency."
Continue reading this entire article:
http://www.sys-con.com/node/2116408
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January 3, 2012
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New research demonstrates how Hepatitis C hijacks a specific, microRNA molecule. The study clarifies why an experimental antiviral drug that binds to this microRNA molecule effectively targets the Hepatitis C virus.
Hepatitis C virus hijacks liver microRNAs to survive
Last Updated: Tuesday, January 03, 2012
Washington: A new study has discovered how hepatitis C virus survives in the liver - helping medical scientists understand why a new antiviral drug appears to be effective against the virus.
Scientists at the University of North Carolina at Chapel Hill, working with colleagues from the University of Colorado, have found for the first time how the hepatitis C virus hijacked a small RNA molecule that regulates gene expression in human liver cells to ensure its own survival.
MicroRNAs are involved in regulating the expression of genes in cells, usually by blocking the production of key proteins or by destabilizing the messenger RNAs that encode the cell's proteins as it grows and divides.
Normally they act by down regulating gene expression.
The research team found that the binding of a prominent microRNA in liver cells, called miR-122, to the viral RNA results in its stabilization, promoting efficient replication of the virus genome in the liver and supporting the virus' lifecycle.
Continue reading this entire article:
http://zeenews.india.com/news/health/diseases/hepatitis-c-virus-hijacks-liver-micrornas-to-survive_15118.html
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Find out about the prevalence, signs and symptoms and treatment for autoimmune hepatitis.
by Nicole Cutler, L.Ac.
Affecting an increasing number of people worldwide, hepatitis is a liver disease characterized by inflammation and/or destruction of liver cells. The most common cause of hepatitis is infection with one of the hepatitis viruses. Other causes include drug overdoses, alcohol abuse, bacterial infection, exposure to plant and chemical toxins, a reaction to certain drugs and the autoimmune condition known as autoimmune hepatitis (AIH).
Autoimmunity
The most prominent responsibility of the immune system is to protect the body from viruses, bacteria and other living organisms. A healthy immune system only reacts against invaders intending harm against the body, not its own cells. However, autoimmunity occurs when the immune system mistakenly attacks the cells it is supposed to protect. Researchers speculate that certain bacteria, viruses, toxins and drugs trigger an autoimmune response in people who are genetically susceptible to developing an autoimmune disorder.
In cases of autoimmune hepatitis, the body's own immune system attacks its own liver cells. Known to occur after infection with Hepatitis A, B or C, autoimmune hepatitis is occasionally confused for a prolonged or relapsing viral hepatitis. Some additional, specific triggers of AIH include:
• The Epstein-Barr virus (EBV)
• The measles virus
• Salmonella bacteria
• Escherichia coli bacteria
In addition, the following medications have been suspected as AIH triggers:
• Halothane
• Interferon
• Minocycline
• Melatonin
• Alpha methyldopa
• Oxyphenistatin
• Nitrofurantoin
Prevalence
Autoimmune hepatitis accounts for 11 to 23 percent of all cases of chronic hepatitis in the United States, affecting 100,000 to 200,000 individuals. Researchers think a genetic factor may predispose some people to autoimmune diseases. About 70 percent of those with autoimmune hepatitis are women, most between the ages of 15 and 40. Similar to other forms of chronic hepatitis, untreated AIH can lead to scarring of the liver (cirrhosis), liver cancer and eventually to liver failure. However, early diagnosis and treatment can help control this illness from progressing.
Women represent about 80 percent of all cases of AIH and two major age groups are affected:
1. Young people between ages 10 and 20
2. People older than 55 years
Up to 17 percent of people with AIH have a second autoimmune disorder, predominantly autoimmune thyroid disease, including both Hashimoto's thyroiditis and Graves' disease. Other autoimmune conditions that typically coexist with AIH include pernicious anemia, autoimmune hemolytic anemia, rheumatoid arthritis, Sjogren's syndrome, ulcerative colitis, myasthenia gravis, glomerulonephritis, celiac disease, vitiligo and type I diabetes.
Signs and Symptoms
Coming on suddenly or gradually, the signs and symptoms of autoimmune hepatitis can range from minor to severe. Although often asymptomatic, signs and symptoms typical of any type of hepatitis include:
• Anemia
• Fatigue
• Abdominal discomfort
• Joint aches
• Itching
• Yellowing of the skin and whites of the eyes (jaundice)
• An enlarged liver
• Abnormal blood vessels on the skin (spider angiomas)
• Nausea and vomiting
• Liver scarring (cirrhosis)
• Fluid in the abdomen (ascites) or mental confusion, in advanced cases
• Dry eyes and mouth (Sjogren's syndrome)
Additionally, people with AIH may have the following signs and symptoms:
• Hemolytic anemia
• Chronic inflammation of the thyroid gland (thyroiditis)
• Inflammation of the colon (ulcerative colitis)
• Diabetes
• Acne
• Puffy facial features
• Hirsutism (increased facial hair)
• Obesity
• Pigmented abdominal striae or stretch marks
• Absent or decreased menstruation
Differentiation
The only way to differentiate one type of hepatitis from another is with laboratory tests. While lab tests will confirm the presence of a particular virus in cases of viral hepatitis, increased blood levels of gamma globulin and one or more antibodies that target the liver will detect AIH.
More specifically, a diagnosis of AIH is best achieved with a combination of the following clinical and laboratory findings:
• Antinuclear antibody (ANA)
• Smooth muscle antibody (SMA)
• Liver/Kidney microsomal antibody (LKM-1)
• Anti-mitochondrial antibody (AMA)
• Immunoglobulin G (IgG)
However, the diagnosis of autoimmune hepatitis always requires a liver biopsy.
Treatment
Although chronic hepatitis due to a virus (such as Hepatitis B or C) is approached by physicians with drugs aiming to annihilate the virus, treatment for AIH is starkly different. Most successful when diagnosed and treated early, therapy for AIH is based on suppressing an overactive immune system.
Clinical studies demonstrate that sustained response to treatment cannot only stop AIH from getting worse, but also may actually reverse some of the damage. While the immunosuppressive drugs used to treat AIH can have significant side effects, approximately 70 percent of those undergoing treatment go into remission within two years of starting treatment. Unfortunately, a majority of AIH sufferers will need to continue with immunosuppressant therapy for years, if not for life. When medications don't halt the progress of the disease or cirrhosis has developed or progressed to liver failure, the remaining option is a liver transplant - a procedure that's often very successful in people with autoimmune hepatitis.
Unlike the various strains of viral hepatitis, autoimmune hepatitis is not contagious. Although not an infectious disease, AIH is a serious illness that can lead to irreversible cirrhosis and liver failure. Because early intervention has demonstrated the best success, those with liver concerns or who exhibit the signs and symptoms can benefit by being aware of and being tested for AIH.
References:
www.autoimmunedisease.suite101.com, Autoimmune Hepatitis Part I, Elaine Moore, 2007.
www.digestive.niddk.nih.gov, Autoimmune Hepatitis, National Digestive Diseases Information Clearinghouse, 2007.
www.gicare.com, Hepatitis, Jackson Siegelbaum Gastroenterology, 2007.
www.liverfoundation.org, Autoimmune Hepatitis, American Liver Foundation, 2007.
www.mayoclinic.com, Autoimmune Hepatitis, Mayo Foundation for Medical Education and Research, 2007.
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