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Although HEV transfusion transmitted infection (TTI) has been reported in some European countries, a large Danish study found no evidence of it in blood donations.
In the study, by researchers from four university hospitals, samples from 25,637 consenting donors collected during one month in 2015 were screened retrospectively using an individual-donation HEV RNA nucleic acid test with a 95% detection probability of 7.9 IU/mL.
Eleven donations (0.04%) were confirmed as positive for HEV RNA (median HEV RNA level, 13 IU/mL). Two donations were successfully genotyped as HEV-gt-3. Only one donor had a travel history outside Europe. Nine of eleven donors were male, but the gender ratio was non-significant compared with the total donor population.
Seven available recipients tested negative for HEV RNA and anti-HEV immunoglobulin M in follow-up samples. One recipient was HEV RNA-negative but anti-HEV immunoglobulin G-positive. HEV TTI was considered unlikely, but a transfusion-induced secondary immune response could not be excluded. Phylogenetic analysis showed relatively large sequence differences between HEV from donors, symptomatic patients, and swine.
The researchers concluded that despite an HEV RNA prevalence of 0.04% in Danish blood donations, all HEV-positive donations carried low viral loads, and no evidence of TTI was found.
Reference
Low transfusion transmission of hepatitis E among 25,637 single-donation, nucleic acid-tested blood donors. Harritshøj LH, Holm DK, Saekmose SG et al. Transfusion. 2016 Jul 7 [Epub ahead of print]
Jul
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New global data show the absolute burden and relative rank of viral hepatitis has increased over the past quarter of a century.
A multi-national team of researchers used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.
Global viral hepatitis deaths increased in that period, from 0.89m to 1.45m, and the sum of years lost went from 31m to 41.6m and years lived with disability from 0.65m to 0.87m. Disability-adjusted life-years increased from 31.7m to 42.5m. In 2013, viral hepatitis was the seventh leading cause of death worldwide, compared with tenth in 1990.
The researchers concluded that, unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. They suggest the enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, represents an important opportunity to improve public health.
Reference
The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Stanaway JD, Flaxman AD, Naghavi M et al. Lancet. 2016 Jul 6 [Epub ahead of print]
Jul
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People with HCV appear to be more impulsive and take more risks than individuals with other liver diseases, a new study suggests.
In the study, at Brazil’s Federal University of Bahia, Brazil, 269 adults with liver diseases were divided into a viral group of 157 patients with HCV and a non-viral group of 112. Risk behaviours were evaluated by a socio-demographic questionnaire. Impulsivity was assessed through Barratt Impulsiveness Scale (BIS-11). Psychiatric comorbidities were investigated by the Mini International Neuropsychiatric Interview 5.0.0.
The viral group patients had higher impulsivity than the non-viral group in all domains: attentional impulsivity, motor impulsivity, and non-planning. Risk behaviours were also shown to be associated with impulsivity levels. The results suggest that HCV-infected patients are more impulsive than individuals with other liver diseases, even when analyses are controlled for the presence of comorbid mental disorders. In addition, at-risk behavior was significantly mediated by impulsivity.
Reference
Risk-taking behavior and impulsivity among HCV-infected patients. Dantas-Duarte A, Morais-de-Jesus M, Nunes AP et al. Psychiatry Res. 2016 Jun 22; 243:75-80 [Epub ahead of print]
Jul
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Collaborative care modestly improved depression among patients treated at chronic HCV clinics, a new study found
Collaborative care models have been shown to improve depression outcomes in primary care settings. The new study was conducted at four chronic HCV clinics in US Veterans Affairs facilities by a collaborative depression care team consisting of a depression care manager, pharmacist and psychiatrist.
Baseline screening identified 263 HCV-infected patients with depression. In unadjusted analyses, intervention participants' reports trended toward more treatment response (19% versus 13%) and remission (12% versus 6%), but total number of depression-free days (50.9) was similar to that of usual care participants (50.7).
These trends did not reach statistical significance for the overall sample in the adjusted analyses: response (odds ratio 2.02), remission (odds ratio 2.63), and depression-free days (7.6). However, the intervention was effective in improving all three outcomes for patients who did not meet criteria for remission at baseline.
Reference
Collaborative care for depression in chronic hepatitis C clinics. Kanwal F, Pyne JM, Tavakoli-Tabasi S et al. Psychiatr Serv. 2016 Jul 1 [Epub ahead of print]
Jul
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A new article reviews the significance of HBV infection and the vaccination and screening measures needed to achieve immunity in children receiving liver transplants.
The review found HBV non-immunity among transplant candidates is higher than expected, even after appropriate completion of the vaccine series. Annual measurement of quantifiable HBV surface antibody in this vulnerable group should guide administration of booster and/or re-vaccination, thus improving immunoprotection.
The authors point out the liver plays a vital role in immune regulation. It induces immune tolerance and competence, and both clears antigens from the circulation and generates liver-primed memory cells through antigen presentation via hepatic scavenger cells. Lymphocyte populations are depleted in patients with liver disease.
The reviewers summarise immunity provided during early childhood against HBV infection is important to both paediatric liver transplant candidates and aging recipients. The field of paediatric transplantation is ripe for further functional cellular and humoral immunity studies on childhood HBV vaccines.
Reference
Hepatitis B immunity in the pediatric liver transplant population. Patel SS, Leung DH. Curr Opin Pediatr. 2016 Jun 29 [Epub ahead of print]
Jul
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This observational, historical cohort study was conducted using administrative data from the [US] Humana Research Database amongst 43,046 appropriate HCV patients diagnosed between 2008, and 2013. Cox proportional hazards models were used to estimate the relative risk of liver transplant by level of treatment adherence (> 80%, 50%-79%, and < 50%) based on proportion of days covered.
Only 2,708 (6.29%) of the patients received HCV treatment, and 366 (<1%) received a liver transplant. Although there were no significant differences in the risk of liver transplant by adherence level, there was an upwards trend in the rate of liver transplant as adherence worsened (> 80%: 1.25%; 50%-79%: 1.30%; and <50%:1.99%), and the average days to liver transplant was longer with higher adherence (> 80%: 683; 50%-79%: 623; < 50%: 454). Only 48 (13.11%) patients who received a liver transplant were treated for HCV.
Adjusted median total and per patient per month health care costs measured from index date until end of the study period were significantly higher for patients who received HCV treatment compared with those who did not (US$231,139 versus US$86,167, and US$20,583 versus US$5,778, respectively), driven by HCV-related medical costs and total pharmacy costs.
Reference
Does hepatitis C treatment adherence affect risk of liver transplantation? A historical cohort study. Ems D, Racsa P, Anderson C et al. J Manag Care Spec Pharm. 2016 Jul;22(7):863-71
Jul
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A total of 363 chronic HCV patients treated outside clinical trials with all-oral DAA regimens at three hepatitis clinics in Spain were retrospectively examined. Host and viral factors were tested as predictors of treatment failure.
All but 14 (4%) patients achieved sustained virological responses. Ten failures occurred after 12 weeks of sofosbuvir-ledipasvir, despite five of them being on ribavirin. All failures but one were relapses. The only patient with viral breakthrough selected NS5B L159F and NS5A Y93H.
In multivariate analyses, only advanced liver fibrosis and HIV coinfection were significantly associated with treatment failure. A trend towards a lower response was seen for HCV genotype 4.
Reference
Rate and predictors of treatment failure to all-oral HCV regimens outside clinical trials. Arias A, Aguilera A, Soriano V et al. Antivir Ther. 2016 Jun 24 [Epub ahead of print]
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This case-control multicentre study in Italy enrolled 571 NHL patients and 1004 cancer-free matched controls.
Circulating HCV RNA was detected in 63 NHL cases and 35 controls (odds ratio 3.51). Chronic HBV infection was found in 3.7% of cases and 1.7% of controls (odds ratio 1.95). There was a significantly elevated odds ratio for B-cell NHL (odds ratio 2.11).
People with serological evidence of past HCV or HBV infection, vaccination against HBV, or detectable antibodies against HBV core antigen alone were not at increased NHL risk.
The researchers suggest that the prevention and treatment of HCV and HBV may diminish the NHL incidence, notably in areas with a high prevalence of hepatitis virus infection.
Reference
Hepatitis B and C viruses and risk of non-Hodgkin lymphoma: a case-control study in Italy. Taborelli M, Polesel J, Montella M et al. Infect Agent Cancer. 2016 Jun 23; 11: 27
Jun
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New evidence suggests that sleeping for a longer time at night may slightly increase the risk of non-alcoholic fatty liver disease (NAFLD) in middle-aged and elderly people.
A total of 8,965 NAFLD-free subjects with a mean age of 61.6 who had enrolled in the Chinese Dongfeng-Tongji cohort study at baseline were divided into five groups dependent on their sleep duration: under six hours, six to seven hours, seven to eight hours, eight to nine hours, and nine hours or more.
During five years of follow-up, 2,197 participants were newly diagnosed as NAFLD. Compared with those reported seven to eight hours of night-time sleep, the multivariable-adjusted odds ratios were 1.21 for those who slept eight to night hours and 1.31 for those who slept over nine hours. However, no significant association was found with short nightly sleep duration, i.e., under seven hours.
The effect of long night-time sleep on the risk of incident NAFLD was attenuated greatly by body mass index in men.
Reference
Night-time sleep duration and risk of nonalcoholic fatty liver disease: the Dongfeng-Tongji prospective study. Liu C, Zhong R, Lou J et al. Ann Med. 2016 Jun 21:1-9. [Epub ahead of print]
Jun
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People who received rabbit antithymocyte globulin induction before liver transplantation had lower rejection rates and improved patient and graft survival than those receiving interleukin 2 receptor blocker.
This was the finding of a retrospective analyses using the University of Washington [Seattle] Transplant Database from 2005 to 2012 for adult primary liver transplant patients. Maintenance immunosuppressive agents were tacrolimus or tacrolimus-mycophenolate mofetil. Among 595 patients, 322 received rabbit antithymocyte globulin and 273 received interleukin 2 receptor blocker.
Acute cellular rejection was higher in those who received interleukin 2 receptor blocker than in those who received rabbit antithymocyte globulin (27% versus 18%).
Both patient survival at one year (95% versus 90%), three years (92% versus 87%), and five years (86% versus 80%) and graft survival at one year (93% versus 88%), three years (90% versus 86%), and five years (83% versus 78%) were superior with rabbit antithymocyte globulin than with the interleukin 2 receptor blocker.
In patients with HCV, the type of induction therapy did not have any effect on the timing of HCV recurrence. At one year after transplant, 33.3% in the rabbit antithymocyte globulin group had grade three to four inflammation and 10.2% had stage three to four fibrosis, compared with 16.8% and 4.8% in the interleukin 2 receptor blocker group.
Female recipient, Model for End-Stage Liver Disease score, hepatocellular carcinoma, and high preoperative serum creatinine levels were associated with less favourable patient and graft survival.
Reference
Superior patient and graft survival in adult liver transplant with rabbit antithymocyte globulin induction: experience with 595 patients. Montenovo MI, Jalikis FG, Li M et al. Exp Clin Transplant. 2016 Jun 15 [Epub ahead of print]
