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A new German study shows, for the first time, that HCV can often be detected in stool samples of chronically infected patients irrespective of occult bleeding. This, say the study authors, suggests that stool could be a potential source for HCV infection.

Researchers at Hannover Medical School retrospectively collected stool samples of 98 HCV patients. Specific HCV primers were used to identify samples positive for HCV RNA. HCV RNA-positive samples were tested for HCVcoreAg with the Architect HCVAg assay. Presence of occult blood was investigated by the hemoCARE guajak test. Viral stability and infectivity of recombinant HCV particles was investigated in vitro by incubation of genotype 2a chimeric virus Jc1 with bile and stool suspensions.

HCV RNA could be detected in 68 out of the 98 stool samples and and 16 samples also tested positive for HCVcoreAg. Presence of HCV RNA in stool was more frequent in male than in female and in patients with low platelet counts but was not associated with the detection of occult blood. Stool suspensions and to a lesser extent bile reduced the in vitro infectivity of genotype 2a chimeric Jc1 virus even though infection of Huh7 cells was not completely abrogated.

The researchers suggest that stool can be a potential source for HCV infection and thus unprotected anal intercourse should be avoided.

Reference

Frequent detection of HCV RNA and HCVcoreAg in stool of patients with chronic hepatitis C. Heidrich B, Steinmann E, Plumeier I et al. J Clin Virol. 2016 Apr 14;80:1-7 [Epub ahead of print]

HCV/HIV co-infection is a factor in mortality prior to liver transplantation and is associated with higher mortality on the waiting list, new evidence shows.

In a study at University Hospital Lozano Blesa, Zaragoza, Spain, among 199 patients with HCV enrolled for liver transplants between 1998 and 2015, 17 were also infected with HIV.

The patients with HCV/HIV co-infection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%). The intention-to-treat survival analysis (ITTA) at one, three and five years was 75%, 64%, and 57% for HCV monoinfection and 52%, 47%, and 39% for HCV/HIV co-infection, respectively. The ITTA at one, three, six and 12 months was 96%, 91%, 87%, and 75% for HCV monoinfection and 76%, 70%, 64%, and 52% for HCV/HIV co-infection, respectively.

A Cox regression analysis was carried out including all variables with predictive value in the univariate analysis, showing that only donor age > 70 years (hazard ratio 3.12), UNOS 1 status (hazard ratio 10.1), MELD (hazard ratio 1.13), and HIV co-infection (hazard ratio 2.65) had independent negative predictive value for survival.

Reference

Intention-to-treat survival analysis of HCV/HIV co-infected liver transplant: Is it the waiting list? Araiz JJ, Serrano MT, García-Gil FA et al. Liver Transpl. 2016 Apr 26 [Epub ahead of print]

Impairment of growth should be considered as part of the risk-benefit profile of peg-interferon/ribavirin therapy in children with HCV, say researchers.

In a global open-label study, the team assessed the five-year follow-up of 107 children and adolescents with HCV who received peg-interferon and ribavirin for 24 or 48 weeks. Ninety-four patients were enrolled in the long-term follow-up part of the study and the median duration of follow-up was 287 weeks.

Of 63 with sustained virologic response enrolled on the study, 54 completed five years of follow-up and none relapsed in this time. Significant decreases in height Z scores were observed during treatment. The impact of treatment on height Z score was larger in patients treated for 48 weeks compared with those treated for 24 weeks (mean change from baseline to the end of treatment was -0.13 and -0.44 in the 24-week and 48-week treatment groups, respectively).

Among patients treated for 24 weeks, full recovery of height Z scores to baseline was observed by year one of follow-up, whereas only partial recovery was observed during five years of follow up in patients treated for 48 weeks (mean change from baseline to the final follow-up visit was -0.16 and -0.32 in the 24-week and 48-week treatment groups, respectively). Similar patterns were observed for weight and body mass index Z scores.

The researchers concluded that considerations should include both deferring treatment in patients during optimal growth periods, and the possibility of interferon-free regimens being available to children in the next five to 10 years. 

Reference

Long-term follow-up of children treated with peginterferon and ribavirin for Hepatitis C virus infection. Haber B, Alonso E, Pedreira A et al. J Pediatr Gastroenterol Nutr. 2016 Apr 21 [Epub ahead of print]

As a probable result of obesity, non-alcoholic fatty liver disease (NAFLD)  is the most common form of chronic liver disease seen in children today, say US reviewers.

The reviewers, from Alfred I duPont Hospital for Children, Wilmington and the Thomas Jefferson University, write that childhood obesity has reached epidemic proportions, and by 2012, more than one third of American children were overweight or obese. As a result, increasingly children are developing complications of obesity including liver disease. In fact, NAFLD disease is the most common form of chronic liver disease seen in children today.

Recently, there has been a burgeoning literature examining the pathogenesis, genetic markers, and role of the microbiome in this disease.

On the clinical front, new modalities of diagnosing hepatic steatosis and hepatic fibrosis are being developed to provide non-invasive methods of surveillance in children. Lastly, the mainstay of treatment of paediatric NAFLD has been largely through lifestyle interventions, namely, dieting and exercise. Currently, there are a number of clinical trials examining novel lifestyle and drug therapies for NAFLD that are registered with the US National Institutes of Health ClinicalTrials.gov website.

Reference 

Paediatric non-alcoholic fatty liver disease. Uppal V, Mansoor S, Furuya KN.Curr Gastroenterol Rep. 2016 May;18(5):24

Metabolic disorders appear to be the biggest risk factors for hepatocellular carcinoma (HCC) and have increased in the last decade, new US evidence suggests.

Researchers at the National Cancer Institute, Bethesda, used data from the Surveillance, Epidemiology, and End Results-Medicare linkage to calculate population attributable fractions (PAFs) for each risk factor over time. A total of 10, 708 patients with HCC who were diagnosed between 2000 and 2011 were compared with 332,107 cancer-free controls residing in the Surveillance, Epidemiology, and End Results areas.

Overall, the PAF was greatest for metabolic disorders (32%), followed by HCV (20.5%), alcohol (13.4%), smoking (9%), HBV (4.3%), and genetic disorders (1.5%). The PAF for all factors combined was 59.5%. PAFs differed by race/ethnicity and sex. Metabolic disorders had the largest PAF among Hispanics (PAF, 39.3%) and whites (PAF, 34.8%), whereas HCV had the largest PAF among blacks (PAF, 36.1%) and Asians (PAF, 29.7%).

Between 2000 and 2011, the PAF of metabolic disorders increased from 25.8% to 36%. In contrast, the PAFs of alcohol-related disorders and HCV remained stable. 

Reference

Population attributable fractions of risk factors for hepatocellular carcinoma in the United States. Makarova-Rusher OV, Altekruse SF, McNeel TS et al. Cancer.