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People with HCV are at a greater risk of the autoimmune disorder, Sjögrens Syndrome (SS), a large Taiwanese study has confirmed.
Researchers, who also found an association between HBV and SS in men, used data from the Taiwan National Health Insurance claims database, entered between 2000 and 2011.
They identified 9,629 SS patients without other concomitant autoimmune diseases and 38,516 sex- and age-matched controls without the condition.
The risk of SS was higher in patients with HCV than in those without chronic viral hepatitis (odds ratio 2.49). Conversely, HBV infection was not associated with SS (odds ratio1.10). Younger HCV patients were at a higher risk for SS (<55 years odds ratio 3.37; ≥55 years odds ratio 2.20).
Men with HCV were at a greater risk for SS (women odds ratio 2.26; men odds ratio 4.22). Only men with chronic HBV exhibited a higher risk of SS (odds ratio 1.61).
Association of Sjögrens Syndrome in patients with chronic hepatitis virus infection: a population-based analysis. Yeh CC, Wang WC, Wu CS et al. PLoS One. 2016 Aug 25;11(8): e0161958
Scottish patients who were successfully treated for HCV had a higher mortality rate than the general population, driven by drug-and alcohol-related causes and liver cancer.
These were the conclusions of a group from Aberdeen, Dundee, Edinburgh and Glasgow who used a Scottish national database to identify 1824 individuals with HCV who attained a sustained viral response (SVR) between 1996 and 2011 and were followed for an average 5.2 years.
In total, there were 78 deaths. All-cause mortality was 1.9 times more frequent for SVR patients than the general population (standardised-mortality-ratio 1.86).
Significant cause-specific elevations were seen for death due to primary liver cancer (standardised-mortality-ratio 23.50), and death due to drug-related causes (standardised-mortality-ratio 6.58). These two causes accounted for 66% of the total excess death observed.
All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (standardised-mortality-ratio 0.70).
Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population. Innes H, McDonald S, Hayes P et al. J Hepatol. 2016 Aug 18 [Epub ahead of print]
A systematic review of published literature has concluded that whilst HEV outbreaks are not new, they remain a continuous global health problem.
An international team of reviewers found that HEV outbreaks have mainly been reported from Asian and African countries and only a few from European and American countries. India has the highest number.
HEV genotypes 1 and 2 were responsible for most large outbreaks in developing countries. During the outbreaks in developing countries, significantly more pregnant women died.
Outbreaks have occurred in open and closed populations. The control measures mainly depend on improvement of sanitation and hygiene.
The global burden of hepatitis E outbreaks: a systematic review. Hakim MS, Wang W, Bramer WM et al. Liver Int. 2016 Aug 20 [Epub ahead of print]
Many vulnerable patients, including refugees, have limited access to HCV and HBV treatment across six major European countries (including the UK).
Researchers from the Netherlands investigated access to treatment for chronic HBV and HCV among six vulnerable patient/population groups at risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs, and people abusing alcohol. The researchers sent an online survey to 235 experts in gastroenterology, hepatology and infectious diseases in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. The 64 responses showed differences in access between and within countries for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for people who inject drugs.
The majority in Hungary and Spain reported significant/complete treatment restriction for all groups, while in Italy there were no/few restrictions. In the UK and Spain, undocumented migrants and people without health insurance were significantly or completely restricted. Opinion about undocumented migrants in Germany and the Netherlands was divergent.
The researchers conclude that their findings suggest a low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality.
Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries. Falla AM, Veldhuijzen IK, Ahmad AA et al. Eur J Public Health. 2016 Aug 19 [Epub ahead of print]
A literature review has cast doubt on whether isolating HCV-infected patients during haemodialysis has any effect on transmission rates.
The Universidad Peruana Cayetano Heredia, Lima, Peru, found only one appropriate study. It covered 12 centres: four used dedicated haemodialysis machines for HCV-infected patients and eight used non-dedicated machines. There were 593 patients enrolled. One centre was excluded after randomisation. Random sequence generation was not described and allocation concealment was not performed. Participants and personnel were not blinded and blinding of outcome assessors was not reported.
Only 74.5% of the patients were followed for nine months; and 47.3% were followed for an additional nine months. The authors only reported one outcome, measuring the difference in incidence of HCV in both groups. The authors did not consider the exposure time, to determine the adjusted rate of seroconversion risk/patient-year.
The study reported that the incidence of HCV infection during the first follow-up period (nine months) was 1.6% in the dedicated group, and 4.7% in the non-dedicated group (risk ratio 0.34). During the second 18 month follow-up the incidence was 1.3% in the dedicated group and 5.8% in the control group (risk ratio 0.22).
The reviewers wrote, “we found no differences in terms of the number of participants developing HCV infection when comparing the dedicated group with the usual care. Moreover, the evidence was of very low quality, which means that we have very little confidence in the effect estimate”. They concluded that the benefits and harms of isolating HCV-infected patients from other patients during haemodialysis are uncertain.
Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units.Bravo Zuñiga JI, Loza Munárriz C, López-Alcalde J. Cochrane Database Syst Rev. 2016 Aug 11;8 [Epub ahead of print]
In a new study amongst haemodialysis patients with HCV, pegylated interferon (Peg-INF) monotherapy resulted in high virological responses and was well-tolerated.
Researchers at New Delhi’s All India Institute of Medical Sciences studied 80 patients on dialysis with HCV infection who were treated with Peg-INF monotherapy. Those with genotype 1 and 4 were given 12 months therapy while those with genotypes 2 and 3 had six months. Mean time from diagnosis of HCV infection and the treatment start was 10.7 months.
Of the 80 patients, 43 had rapid virological responses (RVRs), while 49 had early virological and end of treatment responses. There was no difference related to genotype and 54 percent had sustained virological responses.
All patients had mild flu-like symptoms, 64 required increases in erythropoietin doses, 28developed leukopenia (three treatment-limiting) and 16 developed thrombocytopenia (one treatment-limiting). Five developed tuberculosis, five bacterial pneumonia, and one bacterial knee monoarthritis. None of the patients developed depression.
Pegylated interferon monotherapy for hepatitis C virus infection in patients on hemodialysis: A single center study. Agarwal SK, Bhowmik D, Mahajan S et al. Indian J Nephrol. 2016 Jul-Aug;26(4):244-51
Routine anti-HCV testing at a sexually transmitted infection (STI) outpatient clinic led to earlier HCV detection among HIV-positive men who have sex with men (MSM).
In 2007, routine HCV antibody testing was introduced for MSM with an HIV-positive or unknown status attending a Dutch STI outpatient clinic. Researchers evaluated whether this screening resulted in additional and earlier HCV diagnoses among MSM who also attend HIV clinics.
At first STI consultation, HIV-positive MSM and MSM opting-out of HIV testing (HIV-status-unknown) were tested for HCV antibodies (anti-HCV). During follow-up consultations, only previously HCV-negative men were tested. Retrospectively, STI clinic and HIV clinic HCV diagnosis dates were compared.
At first consultation, 112 of 1,742 HIV-positive and three of 446 HIV-status-unknown MSM tested anti-HCV-positive. On follow-up, 32 HIV-positive MSM became anti-HCV-positive. Four of 34 HIV-positive MSM notified by their sexual partner of HCV tested anti-HCV-positive. Of 163 HIV-positive MSM with HCV antibodies, 78 reported a history of HCV.
HCV diagnosis data at the HIV clinic was requested for the remaining 85 MSM and available for 54 MSM. Of these 54, 28 were diagnosed with HCV at the STI clinic and seven concurrently with HIV. At their next scheduled HIV clinic consultation, three HCV cases probably would have been missed, the researchers suggested.
Earlier detection of hepatitis C virus infection through routine hepatitis C virus antibody screening of human immunodeficiency virus-positive men who have sex with men attending a sexually transmitted infection outpatient clinic: a longitudinal study. van Rooijen M, Heijman T, de Vrieze N et al. Sex Transm Dis. 2016 Sep;43(9):560-5
Many HCV patients – especially men – receiving some anti-viral therapies lose sexual desire.
A total of 181 HCV patients at Taiwan’s China Medical University Hospital tertiary medical centre received peg-interferon (PegIFN)α2a or PegIFNα2b plus ribavirin (RBV), according to response-guide therapy for 24 to 48 weeks. Those with decreased sexual desire before PegIFNα plus RBV were excluded.
All were evaluated using the Mini-International Neuropsychiatric Interview and the 21-item Beck Depression Inventory (BDI). The 21st item of the BDI was used to evaluate decreased sexual desire.
During therapy, 124 of the 181 patients had decreased sexual desire. The BDI score peaked at 14.8 weeks and the severity was greatest at 16 weeks. The average score of the 21st item of the BDI correlated with decreased sexual desire. Depression history and the prevalence of subsequent major depressive disorder after anti-viral therapy was correlated to reduced sexual desire. Male patients complained more significantly than females.
Anti-viral therapy and decreased sexual desire in patients with chronic hepatitis C. Hsiao PJ, Hsieh PF, Chou EC et al. PLoS One. 2016 Aug 9;11(8): e0160450
Nurse-led initiations of antiviral therapy have not lead to an increased uptake or adherence with treatment among people with HCV who inject drugs.
A study involving UK community clinics in London and Surrey compared nurse- and physician-initiated antiviral therapy with pegylated interferon and ribavirin.
Despite easy access to antiviral therapy, treatment uptake was poor, with no significant difference between the groups. The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy.
Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment. Lewis H, Kunkel J, Axten D et al. Eur J Gastroenterol Hepatol. 2016 Aug 3. [Epub ahead of print]
People with type 2 diabetes often have undiagnosed advanced fibrosis and cirrhosis, a new study suggests (1).
Researchers at Pontificia Universidad Católica de Chile, Santiago, studied 145 type 2 patients (median age 60, mean BMI 29.6 kg/m2 and mean diabetes duration 7.6 years).
There was a high rate of liver steatosis (63.9%), advanced fibrosis assessed by NAFLD fibrosis score (12.8%) and evidence of liver cirrhosis assessed by MRI (6.0%). In a multivariate analysis GGT > 82 IU/L and no alcohol intake were independently associated to advanced fibrosis.
A literature review suggested that metformin may improve the survival of diabetic patients with liver cancer (2).
The reviewers, from Central South University, Changsha, China, found 11 studies involving 3,452 liver cancer patients. Metformin use was associated with better survival (hazard ratio 0.59) of liver cancer patients, and the beneficial effect persisted (hazard ratio 0.64) when the population was restricted to diabetic liver cancer patients. Adjusting for age, etiology, index of tumour severity and treatment of liver cancer, the association between metformin use and better survival of liver cancer patients was stable. Pooled hazard ratios ranged from 0.47 to 0.57.
The reviewers warned that the results should be interpreted with caution because of possible residual confounding.
1. High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients. Arab JP, Barrera F, Gallego C et al. Ann Hepatol. 2016 Sep-Oct;15(5):721-8
2. Metformin use improves survival of diabetic liver cancer patients: systematic review and meta-analysis. Ma SJ, Zheng YX, Zhou PC et al. Oncotarget. 2016 Aug 2 [Epub ahead of print]