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HCV Treatment for IDUs and Comorbidities (Cancer, CVD, Kidney, Psych Issues)
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from Jules: here is a collection of recent studies showing those with a history of drug abuse cam be successfully treated, numerous studies show that. Support services are key to many who are marginalized from the healthcare system and currently using drugs. One study below from Mt Sinai in NYS reports non-adherence is key to not achieving SVR. Studies show SVR can reduce kidney disease, CVD risk and other comorbidities. Re-infection remains a concern but support services can be implemented to address this. In HIV we treat IDUs and drug users. A study below at EASL reports "a budget optimization and the potential to eliminate HCV". Without identifying and treating all HCV infected elimination is not possible. Funded programs to provide needed support services are important. At this point in time in the USA federal and state officials are essentially doing nothing towards elimination or in providing funding for widespread screening, linkage to care, and unrestricted treatment access. The Federal government is complicit with State Medicaids in restrictions imposed to treatment access. Clearly over time treatment is less costly than the healthcare costs of HCV and the societal costs. Without the federal government, Congress & The White House committing to a large scale investment in HCV we will not move forward on any of these fronts. Currently, there is no indication the federal government or Congress will do anything on these issues. In NYS as well there is no indication officials will do anything on these issues. Both Federal funding for HCV and NYS funding for HCV has not increased at all over the past few years, funding is at extremely low levels at both the Federal level and in NYS and as I said there is no indication this will change. No State is committed to ending HCV or to removing all restrictions and screening and treating all, and the Federal government knows and accepts this - they are very much complicit in this. In the mid 1990s AIDS activists changed everything in HIV, it was vocal, loud, in your face confrontation & activism by people infected with HIV that did this, but this is not happening in HCV and will not. The AIDS model of activism from that time was a one-time historic unique event.
EASL: Prevention of Liver-Related Complications With Elbasvir/Grazoprevir in Hepatitis C Infected Patients Who Are Receiving Opioid Agonist Therapy (OAT) - (05/26/17)
CROI/2016: Understanding the Relative Contributions of IDU and HCV on Systemic Immune Activation HCV should be aggressively treated in current IDUs even more if HIV and/or HCV positive - (04/4/16)
SVR Reduces Kidney Disease & CVD, Cancer Risk - 'These findings argue for the prescription of HCV therapy in coinfected/all patients regardless of fibrosis stage.' - (05/15/17)
EASL: The cumulative prevalence and incidence of extra-hepatic manifestations in patients with hepatitis C virus infection: real-world evidence from the United States - (05/03/17)
Eradication of HCV and non-liver-related non-AIDS-related events (CVD/diabetes/kidney/cancers) in HIV/HCV coinfection - (02/01/17)
EASL: A budget optimization analysis for the treatment and potential elimination of hepatitis C virus infection in the United States - (05/03/17)
EASL: Elbasvir/Grazoprevir effectiveness in patients with Chronic Hepatitis C and Chronic Kidney Disease: Real-world experience from the TRIO Network - (04/26/17)
C-SURFER: GRAZOPREVIR PLUS ELBASVIR IN TREATMENT-NAIVE AND TREATMENT-EXPERIENCED PATIENTS WITH HEPATITIS C VIRUS GENOTYPE 1 INFECTION AND CHRONIC KIDNEY DISEASE - (04/23/15)
EASL: MAGELLAN-2: SAFETY AND EFFICACY OF GLECAPREVIR/PIBRENTASVIR IN LIVER OR RENAL TRANSPLANT ADULTS WITH CHRONIC HEPATITIS C GENOTYPE 1-6 INFECTION - (04/24/17)
AASLD: EXPEDITION-4: EFFICACY AND SAFETY OF GLECAPREVIR/PIBRENTASVIR (ABT-493/ABT-530) IN PATIENTS WITH RENAL IMPAIRMENT AND CHRONIC HEPATITIS C VIRUS GENOTYPE 1 - 6 INFECTION - (11/15/16)
AASLD: High Rates of Medical and Psychiatric Comorbidities in HIV/HCV-Coinfected Patients Treated With Sofosbuvir-Containing Regimens in Registrational Clinical Trials - Harvoni / Epclusa - (11/17/16)
Real-World Experience of Elbasvir/Grazoprevir in the Veterans Affairs Healthcare System at DDW 2017 - (05/15/17)
AASLD: The Impact of Hepatitis C Viral Cure on Progression of Renal Disease
Zepatier/Trial Underway for Hep C-Positive Kidney Transplants - (12/16/16)
APASL: C-EDGE CO-STAR: Interim Results From the 3-year Follow-up Trial on Risk Factors and Rate of Reinfection in Patients on Opiate Agonist Therapy Previously Treated With Elbasvir/Grazoprevir for 12 Week - (03/15/17)
EASL: Safety and Efficacy of Glecaprevir/Pibrentasvir in Adults With Chronic Hepati is C Virus Infection Genotype 1-6 as a Function of Chronic Kidney Disease Stage - (04/25/17)
AASLD: Elbasvir/Grazoprevir Does Not Worsen Renal Function in Patients With Hepatitis C Virus Infection and Pre-existing Renal Disease - (11/14/16)
AASLD: Non-adherence is the most important risk factor for ledipasvir/sofosbuvir HCV treatment failure in the real world - (11/21/16)
EASL: Early versus delayed hepatitis C treatment provides increased health benefits at lower costs: A UK cost-effectiveness analysis of genotypes 1 and 4 treatment-naïve patients - (05/03/17)
AASLD: Chronic Hepatitis C Virus Infection and Cancer Risks: A Population-Based Cohort Study - (11/14/16)
CROI: Peripheral endothelial function is suboptimal in HCV-untreated, HIV-suppressed adults - - (05/09/17)
EASL: The PREVAIL Study: Intensive Models of HCV Care for People Who Inject Drugs - (04/26/17)
EASL: Efficacy and safety of sofosbuvir/velpatasvir in people with chronic hepatitis C virus infection and recent injecting drug use: The SIMPLIFY study - (04/24/17)
AASLD: ELEVATED HCV REINFECTION INCIDENCE AFTER SUCCESSFUL TREATMENT AMONG HIV-INFECTED MEN WHO HAVE SEX WITH MEN IN SAN DIEGO - (11/21/16)
AASLD: Impact of Drug Use and Opioid Substitution Therapy on Hepatitis C Reinfection: The BC Hepatitis Testers Cohort - (11/21/16)
Does the liver accelerate ageing: Talking muscles and liver? -
The paper from Koo and colleagues provides a unique insight into the relationship between age-related loss of muscle mass, metabolic control and liver disease. We have known the relationship between metabolism, abdominal adiposity and liver health for some time [15]. Although previous reports have shown that sarcopenia relates to NAFLD, it is the extension of this to NASH, independently of insulin resistance, which is of most interest......The paper from Koo and colleagues in the Journal of Hepatology describes the prevalence of sarcopenia in 309 people with biopsy proven healthy liver, non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) [6]. They conclude that as liver disease worsens, the prevalence of sarcopenia rises, with 1 in 4 people with NASH having sarcopenia vs. 1 in 10 for people without liver disease. Multivariate analyses controlling for age, gender, body mass index (BMI), hypertension, diabetes, and smoking status reveal an odds ratio of 2.8 (95% CI, 1.21-4.30).......Ageing is not programmed but results from a gradual, lifelong accumulation of damage to cells and tissues of the body over time. Consequently, there is no single cause for ageing, but spans (not exclusively) the accumulation of mitochondrial DNA mutations, aberrant epigenetic markings, nuclear genome instability and telomere erosion caused by chronic inflammation, metabolic stress and oxidative stress/redox imbalance amongst others [1]. This accumulation of cellular damage drives the ageing process and results in the development of frailty and chronic age-related diseases. Crucially, however, we know that many of the factors involved in the ageing process can be attenuated by lifestyle factors and accelerated with poor lifestyle choices [2] and also with some classes of drugs (such as chemotherapy [3] or anti-retroviral drugs [4]). This creates a disconnect between an individual's biological age and their chronological age - some people age quicker and some people age slower......In the study of Koo et al., sarcopenia was associated with severe fibrosis (≥F2) [6], which raises the possibility of an independent effect of poor liver function. However, cirrhosis was rare in the population (only 7% of cases), and sarcopenia was present throughout the histological spectrum of NAFLD. It is very likely that the altered metabolic milieu of NAFLD (obesity and diabetes) may significantly contribute to accelerate the loss of muscle mass.
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