News Articles 31 - 40 of 160

24
Oct
Comparing the relative renal safety of HBV drugs
News Type: Hepatology News

A new animal study has looked at the relative safety of four anti-HBV drugs against HBV, with respect to kidney function and toxicity.

Researchers at Novartis Institutes for BioMedical Research, Basel, administered telbivudine, tenofovir, adefovir or entecavir to male Spraque-Dawley rats once daily for four weeks by oral gavage at about 10 and 25-40 times the human equivalent dose. Main assessments included markers of renal toxicity in urine, magnetic resonance imaging (MRI) of kidney function, histopathology and electron microscopic examination.

Administration of adefovir at 11 mg/kg and 28mg/kg for four weeks caused functional and morphological kidney alterations in a time- and dose-dependent manner, affecting mainly the proximal tubules and suggesting a mechanism of toxicity related to mitochondrial degeneration/depletion.

For the low dose of 300mg/kg of tenofovir, minor kidney effects such as nuclear enlargement in the tubular epithelium, and hyaline droplets accumulation were detected, which was also observed for the low dose (11mg/kg) of adefovir. No assessments could be done at the higher dose of 600/1,000mg/kg tenofovir due to gastrointestinal tract toxicity, which prevented treatment of the animals for longer than one week.

Entecavir at 1mg/kg and 3mg/kg and telbivudine at 600 mg/kg and 1,600mg/kg caused no toxicologically relevant effects on the kidney.

Reference

Comparative renal safety assessment of the hepatitis B drugs, adefovir, tenofovir, telbivudine and entecavir in rats. Uteng M, Mahl A, Beckmann N et al. Toxicol Sci. 2016 Oct 13 [Epub ahead of print]

17
Oct
People with mental disorders at increased risk of HIV/HCV co-infection
News Type: Hepatology News

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]

 

17
Oct
Elbasvir/grazoprevir tablet effective in previously failed HCV
News Type: Hepatology News

The combination of elbasvir and grazoprevir, with or without ribavirin, was effective in HCV patients failed by previous treatment, a large international study reported.

The study, at 65 centres in Europe, Asia, and Central and North America, assessed the effects of 12 or 16 weeks of a once daily tablet of elbasvir plus grazoprevir, with or without twice-daily ribavirin, in patients with HCV genotype one, four or six. There were 420 patients, of whom 35% had cirrhosis and 64% had a null or partial response to peg-interferon and ribavirin.

With 12 weeks of treatment, an SVR12 was achieved by 92.4% of patients given elbasvir and grazoprevir and 94.2% of patients given elbasvir and grazoprevir with ribavirin.

With 16 weeks of treatment, SVR12 was achieved by 92.4% of patients given elbasvir and grazoprevir and 98.1% of patients given elbasvir and grazoprevir with ribavirin.

Among patients treated for 12 weeks without ribavirin, virologic failure occurred in 6.8%, none, and 12.5% of patients with HCV genotype 1a, 1b, or four infection, respectively.

Also among patients given elbasvir and grazoprevir for 12 weeks, virologic failure occurred in none of the patients infected with HCV genotype 1, and 7.5% of those with genotype 4.

Among patients treated for 16 weeks who received ribavirin, there were no incidences of virologic failure. The treatment was generally well tolerated.

Reference

Effectiveness of elbasvir and grazoprevir combination, with or without ribavirin, for treatment-experienced patients with chronic hepatitis C infection. Kwo P, Gane E, Peng CY et al. Gastroenterology. 2016 Oct 5 [Epub ahead of print]

 

17
Oct
Diet and exercise independently improve fat oxidation in NAFLD
News Type: Hepatology News

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

10
Oct
HBV may reduce risk of stroke
News Type: Hepatology News

New evidence suggests people with HBV are less likely to develop acute ischaemic stroke (AIS).

Researchers at China Medical University Hospital used a Taiwan national insurance claims data set of 1m patients to study 22,303 patients with HBV and 89,212 matched controls from the beginning of 2000 to the end of 2006. Both groups were followed up until the appearance of AIS or the end of 2011.

After adjusting for the relevant covariates, the HBV group exhibited a lower AIS risk (adjusted hazard ratio 0.77) compared with the controls at the end of follow-up. Under the condition of no co-morbidities, patients with HBV had a lower AIS risk compared with the controls (adjusted hazard ratio 0.65). In three age-stratified subgroups, HBV was correlated with a significantly diminished risk of AIS (adjusted hazard ratios at age ≤ 49 years 0.57; at age 50-64 years 0.65; and at age ≥ 65 years 0.96).

The study authors suggest that although a decrease in AIS risk was noted in the patients with HBV, preventing the development of AIS in this population warrants further attention.

Reference

Association of hepatitis B virus infection with decreased ischemic stroke. Tseng CH, Muo CH, Hsu CY et al. Acta Neurol Scand. 2016 Nov; 143(5): 339-345

 

 

10
Oct
HCV patients have body composition changes
News Type: Hepatology News

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

10
Oct
ElastPQ technique accurately assesses liver fibrosis in HCV
News Type: Hepatology News

The ElastPQ technique is reliable and accurate for assessing liver fibrosis in HCV, a new study reported.

Researchers at Italy’s Medical School University of Pavia assessed the performance in staging liver fibrosis of the updated ElastPQ technique (EPIQ7 ultrasound system) in a "real life" setting. A total of 278 chronic HCV patients referred for liver stiffness measurement with the FibroScan 502 Touch device also underwent measurements with the ElastPQ technique.

For the assessment of significant fibrosis, advanced fibrosis and cirrhosis, respectively, the cutoffs of 7, 9.5 and 12kPa were used. The diagnostic performance of ElastPQ was assessed using the area under the ROC curve analysis and was evaluated overall and for cases with (a) 10 measurements and IQR/M</=30%, (b) five measurements and IQR/M </=30%, (c) 10 measurements and IQR/M>30%, (d) five measurements and IQR/M>30%.

The optimal cutoffs of ElastPQ for significant fibrosis, advanced fibrosis and cirrhosis were 6.43, 9.54 and 11.34 kPa, respectively. For measurements with an IQR/M</=30%, there was no statistically significant decrease in sensitivity between 10 and five measurements.

Reference

Accuracy of the ElastPQ technique for the assessment of liver fibrosis in patients with chronic hepatitis C: a "real life" single center study. Ferraioli G, Maiocchi L, Lissandrin R et al. J Gastrointestin Liver Dis. 2016 Sep; 25(3):331-5

03
Oct
Chemotherapy patients with HBV markers need prophylactic antiviral therapy
News Type: Hepatology News

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]

03
Oct
Corticosteroids safe in rheumatologic patients with HBV markers
News Type: Hepatology News

A new study suggests short episodes of corticosteroids seem to be safe in rheumatologic patients with markers of HBV.

The study followed 23 HBsAg or HBcore antibodies positive, anti-HBs negative patients who were hospitalised for a total of 73 times in the rheumatology department at Rambam Health Care Campus, Haifa, Israel, and who each received seven days’ treatment with IV corticosteroids. Eighteen were HBsAg positive. The mean methylprednisolone dose was 33.9 mg/day. Concomitant therapy included disease-modifying anti-rheumatic drugs (DMARDs) in 15, low-dose corticosteroids in eight, and biologicals in 10. Serum HBV DNA was detected at baseline in seven patients.

Three HBsAg-positive patients treated with cyclophosphamide had HBV hepatitis flare-ups with elevated alanine aminotransferase (ALT). Two HBsAg-positive patients had reappearance of HBV DNA in serum after treatment with azathioprine and infliximab, respectively, but the ALT levels remained normal. Lamivudine therapy reduced the serum HBV DNA and improved ALT levels in all patients. Corticosteroid therapy by itself did not trigger exacerbations of HBV. No HBV reactivation occurred in lamivudine-treated patients after recurrent exposure to biologicals or cyclophosphamide.

Reference

Safety of corticosteroid treatment in rheumatologic patients with markers of hepatitis B viral infection: pilot evaluation study. Braun-Moscovici Y, Braun M, Saadi T et al. J Clin Rheumatol. 2016 Oct; 22(7): 364-8

03
Oct
Injecting drug use is a major global risk factor for HCV, HBV and HIV
News Type: Hepatology News

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]