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Interferon Improves Risk for Death and Cancer
New Ribavirin in Early Development
Normal ALT in African-Americans
Fats, Overweight, Diabetes in HCV
How Often Should You Do a Biopsy in HCV/HIV Coinfection
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A Japanese research group reported that interferon therapy improves the
risk for developing HCC and death. This is not a new finding. Several studies
have reported this. But this study was a large one. The study measured ALT
response. Authors reported therapy was 4-12 months & presumably interferon
alone. Responders and transient responders improved risk but non-responders
did not compared to untreated patients. One of the key questions is if you
take IFN+RBV therapy and are a partial responder, relapser or nonresponder
how long will improved histology last after stopping therapy? I don't think
we know but anecdotal opinion is that histology can improve while on IFN even
if you're a nonresponder. After stopping therapy
progression starts up again but it may take a year to get back to where you
were before therapy. Opinion is that by staying on interferon histology
improvement is continued. Two large studies in HCV monodisease are ongoing to
prove this.
Levovirin is a second generation ribavirin being made by ICN Pharmacueticals.
In a poster today they reported that in monkeys they found Levovirin gets
into the red blood cell less than ribavirin. This would suggest perhaps less
side effects. RBV can lead to reduced hemoglobin and fatigue. A study in
HCV-infected patients is planned and required to see if this new version of
RBV has antiviral activity as RBV does in combination with IFN.
A study reported today by Thelma Wiley from the University of Illinois,
Chicago reported finding that in African-Americans compared to non-AAs
cirrhosis was as likely to occur whether ALT is normal or abnormal (25%).
Among the general population, normal ALT implies less progression in general.
Although ALT is not a predictor of non-progression. You could have nomal ALT
and have moderate or more advance liver disease. Wiley said African-Americans
with normal ALT are as likely
to develop significant histologic disease as whites with abnormal ALT.
Several posters associate overweight, elevated fats (cholesterol,
triglycerides), and sugar with HCV and progression. This is not new
information but is worth reporting because these are things that patients can
have some control over with dietm, exercise, and medical intervention for
lipids.
One poster suggested in HCV monodisease a follow-up biopsy should be done 3-5
years after the first to evaluate progression. Since HIV accelerates HCV
perhaps a followup biopsy should be considered 1-2 years after the first, if
HCV therapy was not started.
A San Diego group reported that HCV/HIV patients treated with HAART & for HCV
have better survival if they are compliant with taking meds, participating in
support groups, and in stopping alcohol. In other words, good support systems
are important.
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