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Brief Highlights From Day 1 at AASLD, Poster Session: HCV Therapy 1
Written by Jules Levin
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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. None of these studies looked
at HCv/HIV coinfected patients. 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 improves 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.
Tomorrow is an oral session with several pegylated interferon studies and a
poster on preliminary data from the US study of Pegasys for HCV/HIV
coinfection.
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