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A new review suggests that people with psychiatric diseases may be at an increased risk of HIV/HCV co-infection

The authors, from the University of Barcelona, found that the prevalence of HCV infection among HIV-infected patients is high ranging from 50% to 90%. Patients with psychiatric diseases have also an increased risk for HIV/HCV co-infection.

The most effective strategy to decrease HCV-related morbidity and mortality in co-infection is to achieve viral eradication. Although psychiatric symptoms often appear during antiviral treatment and may be associated with the use of interferon-alpha, recent evidence suggests that many patients with comorbid mental and substance use disorders can be treated safely.

Recent data indicate that interferon-alpha-induced psychiatric side effects have a similar prevalence in HIV/HCV co-infected patients to mono-infected patients and they can be managed and even prevented successfully with psychopharmacological strategies in the frame of a multidisciplinary team. New antivirals offer interferon-free therapies for this specific population.

Reference

Mental disorders in HIV/HCV coinfected patients under antiviral treatment for hepatitis C. Martin-Subero M, Diez-Quevedo C. Psychiatry Res. 2016 Sep 26; 246:173-181 Epub ahead of print]

New research shows diet and exercise training have specific benefits on fat metabolism in patients with non-alcoholic fatty liver disease (NAFLD).

In a study at the University of Queensland, 10 NAFLD patients were randomised to circuit exercise training (EX) for three hours a week, and six patients to dietary energy restriction (ER). Respiratory quotient (RQ) and whole-body fat oxidation rates (Fatox) were determined by indirect calorimetry under basal, insulin-stimulated and exercise conditions. Severity of disease and steatosis was determined by liver histology; hepatic Fatox was estimated from plasma β-hydroxybutyrate concentrations; cardiorespiratory fitness was expressed as VO2peak.

Hepatic steatosis and NAFLD activity scores decreased with ER but not with EX. β-hydroxybutyrate concentrations increased significantly in response to ER but remained unchanged in response to EX. Basal RQ decreased in response to EX, while this change was not significant after ER. Maximal Fatox during aerobic exercise improved with EX but not with ER. The increase in β-hydroxybutyrate concentrations was correlated with the reduction in hepatic steatosis.

Reference

Independent effects of diet and exercise training on fat oxidation in non-alcoholic fatty liver disease. Croci I, Byrne NM, Chachay VS et al. World J Hepatol. 2016 Sep 28;8(27):1137-1148

Chronic HCV patients have both an acquired type of lipodystrophy (particularly in the trunk region) and a reduced bone mineral density (BMD) compared to controls.

These were the findings of researchers at Bucharest’s Carol Davila University of Medicine and Pharmacy, who assessed 60 chronic HCV patients and 60 healthy controls by Dual Energy X-Ray Absorptiometry.

Total fat mass, trunk fat mass and per cent body fat were lower in the HCV patients. Several risk factors were associated with the reduced fat mass: low BMI, cigarette smoking and peg-interferon alpha 2a plus ribavirin treatment. Peg-interferon alpha 2a and ribavirin treatment negatively correlated with lean body parameters, especially in male patients. BMD was lower when compared to controls and was correlated with low body mass index, cigarette smoking and peg-interferon alpha 2a and ribavirin treatment.

Reference

Body composition changes in patients with chronic hepatitis C. Barbu EC, Chiţu-Tișu CE, Lazăr M et al. J Gastrointestin Liver Dis. 2016 Sep; 25(3):323-9

Patients receiving chemotherapy who have serological markers of previous HBV infection remain at risk for reactivation, and need effective pre-emptive antiviral prophylaxis.

This is suggested by the results of a study at Athens University which retrospectively evaluated the medical records of 55 HBsAg-negative, anti-HBc-positive patients with haematological diseases or solid tumours who underwent immunosuppressive therapies and were referred because of positive baseline HBV serology or HBV reactivation.

Of the 55 patients, 31 received antiviral prophylaxis (group one), whereas 24 patients did not receive any anti-HBV agent (group two). The majority of patients had haematological malignancies and most of them received rituximab-containing regimens.

Lamivudine was used as antiviral prophylaxis in 13 of the 31 patients in group one. One patient in this group experienced HBV reactivation and was treated successfully with tenofovir add-on therapy.

All patients in group two experienced HBV reactivation and most of them were treated with tenofovir or entecavir as rescue therapy. Two of these patients (one of the tenofovir/entecavir subgroup and one of the lamivudine subgroup) eventually died because of hepatic failure despite rescue treatment.

The researchers conclude that screening of both anti-HBs and anti-HBc is mandatory before chemotherapy. Pre-emptive antiviral prophylaxis, including lamivudine, is highly effective in all subgroups of such patients, whereas deferring treatment upon HBV reactivation is not enough to rescue all cases.

Reference

Efficacy of prophylactic antiviral therapy and outcomes in HBsAg-negative, anti-HBc-positive patients receiving chemotherapy: a real-life experience. Papadopoulos N, Deutsch M, Manolakopoulos S et al. Eur J Gastroenterol Hepatol. 2016 Sep 23 [Epub ahead of print]

A new analysis of international data shows injecting drug use (IDU) is a major contributor to the global burden of HCV, HBV and HIV.

Previous estimates of the burden of these diseases among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. Therefore, a team of researchers from Australia, the UK and the USA used the Global Burden of Disease Study and United Nations data to study this risk factor.

They estimated 10million disability-adjusted life-years (DALYs) were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990.

In total, in 2013, IDU was estimated to cause 4% of DALYs due to HIV, 1.1% of DALYs due to HBV, and 39.1% of DALYs due to HCV. The IDU-attributable HIV burden was highest in low-to-middle-income countries, and the IDU-attributable HCV burden was highest in high-income countries.

The researchers suggest that effective interventions to prevent and treat these important causes of health burden need to be scaled up.

Reference

Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Degenhardt L, Charlson F, Stanaway J et al. Lancet Infect Dis. 2016 Sep 21 [Epub ahead of print]