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A study in Taiwan found that high concentrations of arsenic in drinking water significantly increased the risk of hepatitis or cirrhosis in people without chronic viral hepatitis. However, the study also found that, in people with chronic viral hepatitis, lower levels significantly reduced the risk.

Researchers examined associations between exposure of arsenic in drinking water and risk of hepatitis and cirrhosis, and the interaction with chronic viral hepatitis, in 4,387 people living in the Lanyang Basin of northeastern Taiwan, where well water has an arsenic content that ranges from undetectable to 3590 μg/L.

The prevalence odds ratios in the overall study population for chronic hepatitis or cirrhosis for well water arsenic concentrations of =10 μg/L were 1.00 (reference), 0.93 for 10.1-49.9 μg/L, 1.24 for 50.0-99.9 μg/L, 0.98 for 100.0-299.9 and 1.86 for =300.0 μg/L.

Increasing levels of arsenic in drinking water were associated with increasing prevalence of chronic hepatitis or cirrhosis in residents who were seronegative for HBsAg and seronegative for anti-HCV, but not for seropositive for either HBsAg or anti-HCV.

In individuals who were seropositive for HBsAg or anti-HCV, there was an inverse association between hepatitis or cirrhosis and consumption of water with levels of arsenic =100.0μg/L. Among participants who were seropositive for HBsAg or anti-HCV, consumption of water with levels of arsenic =100.0 μg/L was associated with a reduced risk of liver cancer (multivariate-adjusted hazard ratio, 0.29). A higher proportion of individuals exposed to cumulative arsenic level >14,000μg/L× year were carriers of inactive HBV and were positive for HBsAg (60%) than individuals exposed to water below this arsenic level (35%).

Reference

Effects of arsenic in drinking water on risk of hepatitis or cirrhosis in persons with and without chronic viral hepatitis. Hsu LI, Wang YH, Hsieh FI et al. Clin Gastroenterol Hepatol. 2016 Apr 6 [Epub ahead of print]

Asians with hepatocellular carcinoma (HCC) appear to have a better health-related quality of life (HRQoL) than Europeans with the same condition, new evidence suggests. 

In a multinational study, 227 patients with HCC from Asian and European countries completed the EORTC QLQ-C30 and the EORTC QLQ-HCC18 questionnaires.

After adjusting for demographic and clinical characteristics, Asian patients still had significantly better HRQoL scores in emotional functioning, insomnia, (QLQ-C30) and in sexual interest (QLQ-HCC18). Researchers also found an interaction in physical functioning (QLQ-C30) and fatigue (QLQ-HCC18) between geographic region and marital status; married Europeans having worse HRQoL scores than Asian singles.

The researchers suggest cultural differences, as well as clinical differences in the pattern of disease owing to active surveillance of Asian countries may explain the results.

Reference

Differences in health-related quality of life between European and Asian patients with hepatocellular carcinoma. Chie WC, Blazeby JM, Hsiao CF et al. Asia Pac J Clin Oncol. 2016 Apr 1 [Epub ahead of print]

In a study at the Cleveland Clinic (1) the combination of sofosbuvir (SOF) and simeprevir (SIM) without riba virin (R) was well tolerated and resulted in high virological response rates in recurrent HCV GT1 infection after liver transplantation (LT).

Sixty-seven patients with HCV GT1 have received SOF+SIM following LT to date: 39% with HCV RNA >6,000,000 IU/mL, 22% with advanced hepatic fibrosis (stage 3-4), 6% with homeostatic recurrence and 58% had previously failed or did not tolerate interferon-based treatments. Mean time from LT to treatment was 6.1 years. All patients had estimated GFR >30 mL/min. Tacrolimus was primary immunosuppression in 84% of patients and minimal immunosuppression dose adjustments were required during treatment. 

In intention to treat analysis, 90% achieved end of treatment virologic response and 88% achieved sustained virologic response.

And in a review from the Université Paris Descartes (2), authors wrote that results from clinical studies as well as preliminary real-life data regarding the combination of SOF (a nucleotide polymerase inhibitor) and daclatasvir, a first-in-class NS5A replication complex inhibitor, demonstrate that it is one of the most promising antiviral therapies for HCV, with once-daily oral dosing, a low pill burden, good tolerability, and limited drug-drug interactions, in addition to high antiviral potency, with over 90% sustained virologic response rates. 

This combination has high pangenotypic antiviral potency regardless of the severity and patient characteristics. The combination of SOF and an NS5A inhibitor with R for 12 weeks appears to be a very good further treatment option in both cirrhotic and treatment-experienced patients whatever the stage of fibrosis.

References

Sofosbuvir and simeprevir without ribavirin effectively treat Hepatitis C Virus Genotype 1 infection after liver transplantation in a two-center experience. Jackson WE, Hanouneh M, Apfel T et al.Clin Transplant. 2016 Mar 28 [Epub ahead of print]

Daclatasvir-sofosbuvir combination therapy with or without ribavirin for hepatitis C virus infection: from the clinical trials to real life. Pol S, Corouge M, Vallet-Pichard A. Hepat Med. 2016 Mar 4;8:21-26.

Researchers claimed “promising results” using a sequential combined therapy with entecavir (ETV) and pegylated interferon (PEG-IFN) in young patients with active chronic HBV. 

In a study at the University of Turin, 39 patients with different HBV genotypes, HBeAg-positive/negative received a sequential therapy with ETV 0.5 mg/day monotherapy for 12 weeks followed by combination of ETV and PEG-IFN α-2a 180µg/week for 12 weeks, then PEG-IFN monotherapy for 36 weeks. 

HBeAg seroconversion rate was 68.2%; HBsAg loss was 33.3%; sustained virological response was 64.1%; primary non-response was observed in eight patients after 12 weeks of PEG-IFN therapy; virological relapse was reported in six patients.  Viral genotype and HBsAg decline were the most important predictive factor for PEG-IFN response. 

The researchers commented that the stopping rule after 12 weeks of PEG-IFN therapy was useful for identify the non-responders. They added that their results should not be generalized, as further investigations were required for the confirmation of this combination approach. 

Reference

Sequential therapy with entecavir and pegylated interferon in a cohort of young patients affected by chronic hepatitis B. Boglione L, Cariti G, Di Perri G et al. J Med Virol. 2016 Mar 27 [Epub ahead of print]

A pilot study suggests chloroquine (CQ), an autophagy inhibitor used to treat malaria, may be a treatment option for HCV non-responders.

Researchers from Iran and the USA studied 10 patients with chronic HCV genotype 1 who were unresponsive to a combination of pegylated interferon alpha and ribavirin. They were randomized to CQ (150 mg daily for eight weeks) or placebo, and were followed for four weeks after CQ therapy. HCV RNA load and plasma alanine transaminase (ALT) levels were measured at baseline, week four (initial response), week eight (end-of-treatment response), and at the end of 12 weeks.

A significant decrease in HCV RNA after the treatments (week eight) was seen in all patients in the CQ group. However, HCV RNA levels increased within four weeks after discontinuation of CQ treatment although they were still lower than baseline. In addition, the ALT normalised during treatment in the CQ group. However, this response was also lost after treatment cessation.

Reference

New use of an old drug: chloroquine reduces viral and ALT levels in HCV non-responders (a randomized, triple-blind, placebo-controlled pilot trial). Peymani P, Yeganeh B, Sabour S et al. Can J Physiol Pharmacol. 2016 Jan 15:1-7 [Epub ahead of print]