A standard component of many hygiene and aesthetic routines, people (both women and men) from a wide range of backgrounds customarily visit their local nail salon. Although few individuals recognize the medical risks associated with this common practice, there is little doubt that nail technicians who don't strictly follow infection control guidelines are in a prime position to spread viral hepatitis. Whether you want to prevent spreading your ailment or protect yourself and others from acquiring this kind of viral illness, make certain the nail salon you frequent is aware of and implements a strict infection control policy.

Those who are diagnosed with chronic Hepatitis B or Hepatitis C are commonly taught how to prevent passing their infection on to other members of their household. Although not spread via casual contact - like hugging, holding hands or sharing food - viral hepatitis is spread through blood-to-blood contact. Known vehicles for microscopic (and easily overlooked) quantities of infectious blood are personal care items. Since tiny blood particles can be transferred from razors, nail clippers, cuticle sticks or clippers, sharing any of these items can lead to a new Hepatitis B or Hepatitis C infection. Most with chronic hepatitis know better than to share these kinds of tools in their home; however, people who visit a nail salon usually fail to realize that the same risk applies there.

Unfortunately, an increasing number of chronic hepatitis cases are being attributed to poor sanitary practices at nail salons. Recently presented at the annual scientific meeting of the American College of Gastroenterology in Washington DC, researchers analyzed a Virginia Department of Health report on the risk of hepatitis in this type of setting. According to Dr. David A. Johnson of Eastern Virginia Medical School, "The risk of transmission of infectious disease, particularly hepatitis B and C, in personal care settings is significantly understudied in the United States."

Regardless of the results that emerge from the studies recommended by Johnson, increasing public awareness of infection control by nail technicians is a necessity. Experts suggest the following to reduce the risk of spreading hepatitis in a nail salon:

• Proper training for all nail salon workers.

• Education about how hepatitis and other blood-borne infections are transmitted.

• Emphasis on the principles of good hygiene and disinfection.

• Strict requirements on personal hygiene, storage, disinfection and inspection.

Currently, there are no federally mandated infection control guidelines for the prevention of hepatitis in nail salons. Since nationwide consumer protection is lacking, licensing requirements lie with local government agencies. As such, salons are regulated by the individual state or municipality they are located in.

Cities like Boston are being more proactive than others to make manicures and pedicures safe for customers. In 2011, the Boston Public Health Commission voted to require annual licensing and regular inspections of the city's nail salons. Under the new regulation, tools have to either be cleaned and disinfected after each use or disposed of, foot spas have to be sanitized after each customer and at the end of the day, and nail technicians have to wear impermeable gloves when handling potentially dangerous chemicals or when performing any procedures with the risk of breaking the client's skin. Although this legislation was primarily enacted to protect the health of nail salon workers, it also serves to protect against the spread of viruses like hepatitis.

Regardless of the safety precautions that nail technicians should follow, there are gaping violations in infection control practices in a substantial number of salons. The following is intended to help guide educated consumers on how to safely receive a manicure or pedicure:

• Ask the salon staff how they clean and disinfect their equipment.

• Observe the nail technicians to check for tools being reused without being sterilized.

• Bring your own clippers, razors, buffers and nail files with you.

• If hygiene doesn't seem to be a salon's priority, take your business elsewhere.

Getting a manicure or pedicure is supposed to be an enjoyable, relaxing experience. Unfortunately, the possibility of acquiring a viral hepatitis infection is a real threat when visiting a salon that does not practice good infection control. Until there is better legislation and enforcement of nail salons in the U.S., being an educated consumer offers significant protection. By inquiring about and observing the hygiene of your chosen salon - and bringing your own personal care tools - you can be an educated consumer and reduce your risk of acquiring viral hepatitis.

References:

http://files.nailsmag.com/Handouts/NAILSDisinfectionChart.pdf, NAILS State-by-State Guide to Disinfection Regulations, Retrieved January 27, 2011, NAILS Magazine, August 2008.

http://naturalsociety.com/nail-salon-manicures-pedicures-spreading-hepatitis-b/, Some Nail Salon Manicures and Pedicures Spreading Hepatitis B, Anthony Gucciardi, Retrieved January 23, 2012, Natural Society, 2012.

http://www.huffingtonpost.com/2011/11/14/hepatitis-nail-salon_n_1091725.html, Hepatitis And Nail Salons: What You Need to Know, Deborah Dunham, Retrieved January 23, 2012, TheHuffingtonPost.com, Inc., 2012.

http://www.infectioncontroltoday.com/news/2011/10/hepatitis-transmission-risk-in-nail-salons-barbershops-needs-to-be-studied.aspx, Hepatitis Transmission Risk in Nail Salons, Barbershops Needs to be Studied, Retrieved January 23, 2012, Virgo Publishing, LLC, 2012.

http://www.nlm.nih.gov/medlineplus/news/fullstory_118196.html, Hepatitis May Lurk at Barbershops, Nail Salons, Robert Preidt, Retrieved January 23, 2012, HealthDay, 2012.

http://www.universalhub.com/2011/new-regulations-put-bite-nail-salons, New Regulation Puts Bite on Nail Salons, Retrieved January 27, 2012, Adam Gaffin, 2012.

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.

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

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

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

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/#

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/

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

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

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.

By Benzinga Staff

December 22, 2011

Six months post-launch of Vertex's Incivek (telapravir) and Merck/Roche's Victrelis (boceprevir), specialists report a significant increase in usage of both products in their genotype 1 HCV patients compared to one month post-launch. Incivek remains the market share leader, though the gap in preference for Incivek over Victrelis is beginning to narrow compared to previous waves of research. Surveyed hepatologists reported using significantly more Incivek than infectious disease specialists.

In LaunchTrends®: Victrelis (boceprevir) and Incivek (telapravir) Wave 3 BioTrends surveyed a total of 83 physicians (gastroenterologists, hepatologists, and infectious disease specialists) and conducted in-depth qualitative interviews with a subset of the respondents about their current perceptions, early experience and anticipated future use of these products. In addition, feedback around patient type, product satisfaction, patient influence, obstacles to use, and promotional activities is captured.

Continue reading this entire article:
http://www.benzinga.com/pressreleases/11/12/b2226050/incivek-and-victrelis-usage-as-part-of-triple-therapy-hepatitis-c-regim

Viread®, also known as tenofovir disoproxil fumarate, is a medicine used to treat chronic Hepatitis B. Since there are so many variables involved in treating the Hepatitis B virus, navigating through the medications can be confusing. If you are considering taking tenofovir, make sure you understand this powerful drug's strengths and weaknesses.

One of the newest antiviral drugs approved by the U.S. Food and Drug Administration (FDA) to treat Hepatitis B, tenofovir is a nucleotide analogue reverse transcriptase and Hepatitis B polymerase inhibitor. This type of drug interrupts important steps in the virus's reproductive cycle by stopping or interfering with DNA formation or replication. Although considered to be one of the most potent Hepatitis B medications, a 300-mg daily tablet of Viread® does not cure Hepatitis B. However, it is gaining a great deal of support because tenofovir:

• can significantly reduce Hepatitis B viral load.
• helps a small percentage of infected people clear the Hepatitis B virus.
• has a low potential for drug resistance.
• may improve the liver's condition.

The Hepatitis B virus's reproductive cycle is complex, and each type of antiviral medication disrupts a different step in that cycle. Over time, the Hepatitis B virus can develop drug resistance by mutating to avoid harm from a specific drug. Because antiviral drugs are typically taken for a long stretch of time, choosing a medication with a low incidence of drug resistance is highly desirable.

Although there are many factors that contribute to a decision on how to treat chronic Hepatitis B, therapy is usually advised when:

• Those who are Hepatitis B e antigen (HBeAg)-positive have a DNA level of greater than 20,000 IU/mL and when serum alanine aminotransferase (ALT) is elevated for 3-6 months.

• Those who are Hepatitis B e antigen (HBeAg)-negative have a DNA level of greater than 2,000 IU/mL and when serum ALT is elevated (ALT levels >20 U/L for females; 30 U/L for males) for 3-6 months.

Currently, tenofovir is one of four primary drugs used to help treatment-naïve Hepatitis B patients - although ongoing trials are investigating many new substances and drug combinations. The four drugs used as a first-line treatment for Hepatitis B include:

1. interferon alfa (IFN-a)
2. adefovir
3. entecavir
4. tenofovir

While a knowledgeable physician's expertise is needed to ascertain the right treatment for any person, several studies involving tenofovir give us encouraging information about this drug.

• Being a relative newcomer to the Hepatitis B arsenal, there is limited safety information for this drug. However, a study published August 2011 online in Hepato-Gastroenterology found that tenofovir was safe and effective in the long-term management (three years) of HBeAg-positive and HBeAg-negative patients with chronic Hepatitis B.

• Since spontaneous reactivation of chronic Hepatitis B virus can cause a sudden, severe worsening of liver disease, Indian researchers sought alternatives to a liver transplant for those with acute-on-chronic liver failure. As published in the March 2011 edition of the journal Hepatology, they found tenofovir to significantly reduce Hepatitis B viral load and improve the liver's condition in those with severe spontaneous reactivation of chronic Hepatitis B presenting as acute-on-chronic liver failure. The outcome with tenofovir greatly reduced the mortality rate in this group of high-risk individuals.

No potent drug is without its caveats, Viread® included. According to the manufacturer, Viread® can cause serious side effects, including:

• Lactic acidosis - A buildup of acid in the blood is a serious medical emergency that can be fatal. Signs that require immediate medical attention include feeling very weak or tired, unusual muscle pain, breathing difficulty, stomach pain with nausea/vomiting, feeling cold (especially in the arms and legs) feeling dizzy or lightheaded, or having a fast or irregular heartbeat.

• Severe liver problems - Be aware that the liver can become enlarged or fatty with this medication. Signs of a severe liver problem that require immediate medical attention include jaundice (yellow skin or whites of the eyes), dark-colored urine, light-colored stool, loss of appetite for several days, nausea or stomach pain.

• Exacerbating factors - Lactic acidosis or severe liver problems are more likely to occur in females, those who are obese or those who have been taking Viread® or similar medicine for a long time.

• Flare-up - Hepatitis B infection may worsen if Viread® is stopped. Therefore, stopping this medication must be done under the advice and guidance of a knowledgeable physician.

So far, the data that has surfaced demonstrates tenofovir to be a key player in managing the chronic Hepatitis B virus. Although this medication can suppress viral load and improve liver health, it is not a cure for Hepatitis B. In addition, only time will tell if drug resistance remains low with Viread® and if long-term use of tenofovir is safe.

References:

http://emedicine.medscape.com/article/177632-treatment, Hepatitis B Treatment and Management, Nikolaos T Pyrsopoulus, MD, PhD, MBA, FACP, Retrieved December 25, 2011, WebMD, LLC, 2011.

http://onlinelibrary.wiley.com/doi/10.1002/hep.24109/abstract, Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure, Hitendra Garg, et al, Retrieved December 25, 2011, Hepatology, March 2011.

http://www.gastrojournal.org/article/S0016-5085(10)01499-X/abstract, Three-Year Efficacy and Safety of Tenofovir Disoproxil Fumarate Treatment for Chronic Hepatitis B, E. Jenny Heathcoate, et al, Retrieved December 21, 2011, Gastroenterology, January 2011.

http://www.hbvadvocate.org/hepatitis/factsheets_pdf/Treatment-first.pdf , Which Hepatitis B Drug Treatment to Use First, Christine M. Kukka, Retrieved December 25, 2011, Hepatitis C Support Project, 2011.

https://www.hepato-gastroenterology.org/?p=1897, Comparison of the Efficacy of Entecavir and Tenofovir in Chronic Hepatitis B, Fatih Güzelbulut, et al, Retrieved December 21, 2011, Hepato-Gastroenterology, online August 2011.

http://www.hivandhepatitis.com/hep_b/news/2011/0510_2011_a.html, Tenofovir Improves Outcomes of HBV Acute-on-Chronic Liver Failure, Liz Highleyman, Retrieved December 24, 2011, hivandhepatitis.com, 2011.

http://www.viread.com/en/, VIREAD®, Retrieved December 21, 2011, Gilead Sciences, Inc, 2011.

A significant percentage of those living with chronic Hepatitis C infection find themselves dealing with an array of oral health challenges. Bruxism, otherwise known as grinding, gnashing or clenching the teeth is a common habit that can be especially problematic for those managing the Hepatitis C virus (HCV). To protect yourself from the potential pitfalls of bruxism, make sure you know what makes it worse, what to look out for and how to put an end to this tension-building, potentially harmful habit.

Bruxism Causes
Even though there are a number of causes linked to bruxism, HCV in and of itself is not directly responsible for jaw clenching. However, several of the known precipitators of bruxism are often associated with Hepatitis C. Typical culprits include:

• Stress
• Anxiety
• Misalignment - where the upper and lower teeth don't fit together properly
• Smoking
• Excessive drinking
• Sleep disorders
• Antidepressant medications - such as SSRIs
• Neuromuscular disease of the face

Between its social implications, symptoms, treatment, management and progression, those with chronic HCV are not strangers to stress or anxiety. The pressures of living with this liver virus tend to spawn tension - which frequently lodges in the jaw and can lead to bruxism. Additionally, Hepatitis C patients may contend with sleeping problems and/or depression. Antidepressants, one of the known causes of bruxism, are commonly prescribed for HCV.

Symptoms and Effects of Bruxism
Just as the degree by which someone clenches his or her jaw or grinds his or her teeth ranges from mild to severe, so are the severity of symptoms. Symptoms that may point to bruxism include:

• Stress
• Anxiety
• Depression
• Ear or jaw pain
• Insomnia
• Injured gums

If steps are not taken to ease bruxism, the symptoms can intensify and create more unwanted effects such as:

• Teeth Sensitivity - Continual grinding of the teeth can slowly wear away the outer enamel of the teeth and can lead to sensitivity.

• Physical Damage - Besides wearing down enamel, excessive grinding can also damage teeth and dental fillings, loosen teeth and cause recession of the gums.

• Local Pain - The muscular tension created by bruxism can lead to facial pain, intense headaches and jaw pain. The jaw pain is frequently linked to misalignment of the temporomandibular joint - a disorder that has been described as excruciating.

Bruxism Co-Factor
Formally known as xerostemia, a dry mouth is extremely common in those with Hepatitis C. Studies have shown an increased incidence of xerostemia in those with HCV, especially if on antidepressants. The mouth's natural lubrication has many roles, including cleaning, chemical protection and antibody formation. As such, insufficient saliva can have an array of detrimental effects on oral health.

Indicators of xerostemia include:

• A severely dry mouth - especially at night
• Sore oral tissues - particularly gums, tongue and cheeks
• Frothy, foamy and stringy saliva
• Difficulty talking, eating and swallowing
• Bad breath
• Dental decay and tooth sensitivity

Gone untreated, a severe case of xerostomia can lead to increased levels of tooth decay and mouth infections. According to Dr. Martin Greenberg, chairman of the department of the School of Dental Medicine at the University of Pennsylvania, "If a patient has a dry mouth, the chance of dental caries (cavities) climbs."

When it comes to tooth decay and sensitivity, adding xerostemia to bruxism magnifies the likelihood of poor oral health. Those with HCV are especially prone to both conditions. Thus, these individuals are advised to be proactive in minimizing their jaw's tension and maximizing their mouth's lubrication.

Being Proactive
Tips for managing dry mouth and teeth clenching can go a long way in preserving teeth. The management of xerostemia generally involves the following:

• Boosting the mouth's lubrication with sugar-free chewing gum, increased fluid intake and artificial saliva (if necessary).

• Improving oral hygiene (regular brushing and flossing) to remove as much dental plaque as possible.

• Using saliva replacements to protect against the breakdown of oral tissues.

Key ways to manage bruxism involve:

• Stress Relief - To contend with bruxism, experts suggest stress relief as one of the most important treatments. Stress relief could entail counseling, therapy, biofeedback, exercise, yoga, meditation, aromatherapy or receiving a massage. Whatever solution works best for you, find a healthful stress relief approach to prevent bruxism from continuing.

• Teeth/Jaw Alignment - If the bruxism is linked to dental problems, a dentist will evaluate correcting the teeth or jaw alignment. This could involve crowns or onlays to give a new shape to the teeth biting surfaces, or a mouth guard or bite plate to protect teeth and realign the jaw.

• Medication Switch - If you take antidepressant medications and grind your teeth, make sure to discuss it you're your physician, as the problem may be solved by switching to a different antidepressant.

For some, bruxism is mild and may not require treatment. However, teeth grinding has the potential to damage teeth - especially when paired with a dry mouth. Since those with Hepatitis C seem to be prone to both of these conditions, it's important to know their signs and symptoms, seek regular dental care, practice good oral hygiene and be proactive in managing your mouth.

References:

http://www.care2.com/greenliving/7-things-your-teeth-say-about-your-health.html, 7 Things Your Teeth Say About Your Health, Lara, Retrieved October 30, 2010, Care2.com, Inc., 2010.

http://www.hda-online.org.uk/dentistry/bruxism-teeth-grinding/index.html, Bruxism and Teeth Grinding, Retrieved October 30, 2010, Health Development Advice, 2010.

http://www.hep.org.au/documents/Dental-140KB.pdf, Dental Health and Hepatitis C, Retrieved October 30, 2010, National Hepatitis Education Program, 2010.

http://www.hepatitis-central.com/mt/archives/2007/10/10_helpful_tips.html, 10 Helpful Tips: Reducing Dry Mouth for Hepatitis C, Nicole Cutler, L.Ac., Retrieved October 30, 2010, Natural Wellness, 2010.

http://www.mayoclinic.com/health/bruxism/DS00337, Bruxism/Teeth grinding, Retrieved October 30, 2010, Mayo Foundation for Medical Education and Research, 2010.

PBR Staff Writer

Published 12 December 2011

Vertex Pharmaceuticals and Alios BioPharma, together have initiated two clinical studies for the nucleotide analogues ALS-2200 and ALS-2158, inhibitors of the hepatitis C NS5B polymerase.

ALS-2200 and ALS-2158 are pan-genotypic nucleotide analogues, designed to inhibit the replication of the hepatitis C virus by acting on the NS5B polymerase.

The two Phase 1 studies will be randomized, double-blind, placebo-controlled studies, with the primary goals of evaluating the safety and tolerability of single ascending doses of ALS-2200 and ALS-2158 in healthy volunteers and of multiple ascending doses in people with chronic genotype-1 hepatitis C.

Continue reading this entire article:
http://contractresearch.pharmaceutical-business-review.com/news/vertex-alios-biopharma-commence-studies-for-hepatitis-c-treatment-121211

By: HEIDI SPLETE, Internal Medicine News Digital Network

NATIONAL HARBOR, MD. - Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Continue reading this entire article:
http://www.internalmedicinenews.com/news/gastroenterology/single-article/hcv-infection-may-predict-coronary-artery-disease/874f7f1da1.html