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Hepatitis C: What’s New? Part 1

I don’t know if any of my blog readers read the HCV Advocate, a newsletter that I have been contributing to for nearly fifteen years. Here is an excerpt from one of my columns, HCV Snapshots. It highlights some of the posters presented at the 2012 Liver Meeting.

Abstract # 97 Nonalcoholic Fatty Liver Disease without Cirrhosis is an Emergent and Independent Risk Factor of Hepatocellular Carcinoma: A Population Based Study

Authors R.N. Rahman and J.A. Ibdah

Results and Conclusion Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease, with increasing prevalence and severity. This research looked at the relationship between NAFLD and primary hepatocellular carcinoma (HCC) in surveys from 1993-2007. Cases where there was another HCC risk factor, such as hepatitis B or C infection, were excluded.

The results found that NAFLD was the third most common risk factor for HCC, following viral and alcohol-related hepatitis. HCC from NAFLD has been increasing since 1993.

Editorial Comments The link between obesity and liver disease was a hot topic at this year’s liver meeting. The bottom line is that if you have hepatitis C, avoid excessive weight gain, high cholesterol or insulin resistance as you risk adding a second liver disease to your health problems.

Note: A related abstract (# 940) Dietary Cholesterol Intake is Associated with Liver Disease Progression in Hepatitis C Infection: Analysis of the HALT-C trial, authored by Yu and Ioannou, showed that high dietary cholesterol intake was associated with increased risk of disease progression in hepatitis C (HCV) patients with advanced fibrosis and compensated cirrhosis.

However, it wasn’t all bad news. Abstract #99, entitled Coffee Consumption in NAFLD Patients with Lower Insulin Resistance is Associated with Lower Risk of Severe Fibrosis by Kiran Bambha et al., reinforced previous studies that found increased coffee intake is associated with reduced risk of NAFLD and insulin resistance.


Abstract # 136 Medication Use in Patients with Chronic Hepatitis C (HCV) from a U.S. Commercial Claims Database: Inadequacy of Prescribing Information for Assessment of Potential Drug Interactions

Lead Author C.L. Mayer, et al.

Results and Conclusion Many drugs have the potential to interact with boceprevir (BOC) and telaprevir (TVR) which puts patients at risk for drug-to-drug interactions (DDI). This study looked at the pharmacy records of more than 53,000 HCV patients, and identified twenty of the most commonly prescribed drugs. The prescribing information was reviewed, looking for those that have the potential for DDI with BOC and TVR:

  • 5% are contraindicated with either BOC or TVR
  • 5% have recommendations to avoid use for BOC; 15% for TVR
  • 25% have recommendations to reduce the dose and/or monitor for BOC; 35% for TVR
  • 65% lack a recommendation in the prescribing information for BOC; 45% for TVR

The researchers concluded that current prescribing information does not adequately prepare practitioners to assess DDI. The most common drugs found were: zolpidem, diazepam, codeine, bupropion, prednisone, trazodone, tramadol, fluconazole, citalopram, sertraline, fluticasone, clarithromycin, methylprednisolone, sildenafil, alprazolam, clonazepam, amlodipine,  simvastatin, escitalopram, and venlafaxine.

Editorial Comments Although we depend on our medical team to keep us safe, the best course of action is to check any drugs or supplements prior to taking them. Use a drug interaction tools, such as www.hep-druginteractions.org

Note: A related abstract (# 1906), Active Ingredient Confusion for Acetaminophen-Containing Medications: A Cause of Double Dipping presented by M. Serper, found that acetaminophen was identified on the prescription label by the abbreviation “APAP” or “ACET” 87% of the time. About 59% of bottles had a warning regarding APAP. Patients are advised not to exceed 4 grams of acetaminophen daily (in divided doses throughout day), and with inadequate labeling, patients may not readily identify that they are taking acetaminophen. Excess acetaminophen is associated with a risk for hepatotoxicity, so if they take a prescribed dose of acetaminophen along with over the counter acetaminophen, they may risk liver damage. The Investigators recommended elimination of abbreviations on prescription labels.


Abstract #942 Response to Treatment as a Predictor of Hepatocellular Carcinoma (HCC) Development among Persons Chronically Infected with Hepatitis C Virus (HCV) Infection: A Meta-Analysis

Lead Author Rebecca Morgan, et al.

Results and Conclusion Patients with HCV have approximately a 1%-3% chance of developing hepatocellular carcinoma (HCC). The HCC risk for patients who have a sustained virologic response (SVR) to treatment, is a question that has been analyzed before but merits more analysis. In this study, researchers identified and analyzed 10,580 citations, selecting 304 articles and 29 observational studies.

They found that achieving SVR reduces risk of HCC development by more than 75%. Also noted is the absolute risk of HCC among persons with advanced liver disease is nearly three times the risk among persons with all stages of fibrosis (4.6% and 13.9%, respectively). The researchers concluded that earlier treatment with effective therapies is essential to prevent development of HCC in HCV-infected persons.

Editorial Comments As we wait for potential improvements in HCV antiviral therapy, one of the dilemmas from postponing treatment is that advanced liver disease is less likely to respond to treatment. Essentially the delay is a calculated risk. The decision of when to do treatment is individualized and should be made with medical advice.  (For more on this, see last HCV Snapshot Abstract #CRW-5 and HCV Advocate’s newest pamphlet, To Treat – Not to Treat)

Another note: regardless of whether you have or had HCV, take measures to avoid fatty liver disease, which can increase your risk of HCC.


Abstract # 987 Effect of Chronic Hepatitis C Virus Infection on Bone Mineral Density

Lead Author Jung-Chun Lin, et al.

Results and Conclusion One question about HCV is its affects on bone marrow density. This study enrolled 69 subjects with non-cirrhotic HCV (41% male/mean age of 54 years). Compared to the control group of similar age and gender distribution, HCV patients showed significant bone loss. Bone loss increased with more advanced fibrosis levels.

Editorial Comments It would be interesting to see this study done with a third arm measuring the impact of weight-bearing exercise on bone density in people living with HCV.




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