Pegylated Interferon plus Ribavirin Has High Sustained Response Rates in Children with Hepatitis C

Hepatitis C Research and News:

SUMMARY: Children with hepatitis C virus (HCV) infection who were treated with pegylated interferon plus ribavirin showed a high rate of sustained virological response, greater than that seen in most adult studies, according to a report in the June 2010 Journal of Hepatology. Nearly 60% of children with hard-to-treat HCV genotypes including 1 and 4 -- and more than 90% of those with easier-to-treat genotypes 2 or 3 -- achieved a cure.

By Liz Highleyman

Studies of combination interferon-based therapy for chronic hepatitis C usually focus on adults, who typically demonstrate sustained virological response (SVR) rates of just under 50% for HCV genotype 1 and 70%-80% for genotypes 2 or 3 using a standard regimen of pegylated interferon plus ribavirin for 48 or 24 weeks, respectively. Treatment of children with hepatitis C has not been as extensively studied.

In the present study, Etienne Sokal from Catholic University Louvain in Belgium and an international team of colleagues evaluated the safety and efficacy of pegylated interferon alfa-2a (Pegasys) plus ribavirin in previously untreated HCV antibody positive children with detectable HCV RNA viral load.

This prospective analysis included 18 children with HCV genotypes 2 or 3, who were treated for 24 weeks, and 47 children with harder-to-treat genotypes 1, 4, 5, or 6, who were treated for 48 weeks.

Results

• 83% of the genotype 2/3 children and 57% of the genotype 1/4/5/6 children achieved early virological response at week 12.
• End-of-treatment response rates were 94% (at week 24) and 57% (at week 48), respectively.
• Relapse rates were low, with 89% of easier-to-treat participants and 57% of hard-to-treat children achieving sustained response at 24 weeks after completion of therapy.
• 10 participants overall (15%) stopped treatment prematurely -- 2 due to serious adverse events and 8 due to lack of virological response at week 24.
• 15 children overall (23%) had their pegylated interferon or ribavirin doses adjusted -- 11 (17%) due to neutropenia and 3 (5%) due to anemia.
• The most common treatment-related adverse events included:

--Fever and flu-like symptoms (54%);
--Abdominal pain (38%);
--Irritability, depression, or mood changes (34%);
--Dermatitis (29%);
--Vomiting (23%);
--Loss of appetite (22%).

• Interferon-based treatment had no observed effect on the children's growth in height.

These results, the researchers concluded, show that children have an improved rate of sustained virological response compared with reference studies of adult chronic C patients treated with similar regimens.

Investigator affiliations: Université Catholique de Louvain, Cliniques universitaires St Luc, Bruxelles, Belgium; Paediatric Gastroenterology, Hospital de clinicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Hepatologica Pediatrica, Hospital das clinicas da faculdade de medicina da universidade de Sao Paulo, Sao Paulo, Brazil; Department of Pediatrics, Stradinš University, Riga, Latvia; Department of Paediatrics, CLINTEC, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Liver Unit, Birmingham Children's Hospital, Birmingham, UK.

8/31/10

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Newly Recognized Factor in Mother-to-Child Transmission of Hepatitis C

In general, the children of women infected with Hepatitis C have a low risk of being born with the virus. In addition to what was previously known about this type of Hepatitis C transmission, new research finds a genetic link that can aid - or prevent - this from occurring.

by Nicole Cutler, L.Ac.

Many women with a chronic viral infection are weary of procreating, because of the chance they may pass their illness on during pregnancy or birth. For those infected with Hepatitis C, this fear is especially pronounced.

There are a handful of reasonable causes supporting a fear of carrying a baby and giving birth with Hepatitis C. They include:
· Hepatitis C is rampant in our society - affecting approximately four million Americans.
· Hepatitis C often leads to chronic liver disease.
· There is currently no guaranteed cure for Hepatitis C.
· Nearly half of those with Hepatitis C are unsure as to how they originally became infected.

Known as vertical transmission, the risk of infants acquiring Hepatitis C from their mother during pregnancy or childbirth is surprisingly low. There have been quite a few studies examining what the likelihood is of vertical transmission and what increases or decreases the risk of infecting a newborn with Hepatitis C.

Although the statistics determining the rate of vertical transmission is not uniform among these studies, experts believe the most accurate estimate of vertical transmission from mothers with Hepatitis C is five percent. Based upon a comprehensive review of trials investigating Hepatitis C vertical transmission, the following appear to represent the two largest risks for bearing a child with Hepatitis C:
1. The mother is co-infected with Hepatitis C and HIV.
2. The mother has a high Hepatitis C viral load during birth.

In addition, physicians typically relay the following information to pregnant women with Hepatitis C:
· The presence of Hepatitis C infection does not appear to result in a higher risk pregnancy or a higher incidence of poor obstetric outcome.
· Testing for the presence of Hepatitis C in infants born to infected mothers should not begin until at least one year following delivery. The natural history of Hepatitis C infected infants is poorly understood at this time.
· Prophylactic caesarian section is not recommended in Hepatitis C infected mothers. The role of cesarean delivery in mothers co-infected with Hepatitis C and HIV remains controversial.
· Breastfeeding presents a negligible risk of Hepatitis C transmission. Given the well-documented benefits of breastfeeding, it is highly recommended.

It has been a while since there were any additional factors recognized to affect the likelihood of vertical transmission. However, researchers from Italy have recently identified a genetic component that reliably foretells this possibility.

As published in the July 2009 edition of the journal Virology, a mismatch between genes carried by a mother and her infant appear to confer protection against Hepatitis C transmission. Elena Bevilacqua and colleagues from Italy investigated the role of several genes known to play a role in Hepatitis C infection. These researchers found that a specific gene, HLA-DRB1, could predict whether or not the infant acquires Hepatitis C infection from its mother. Based on this research:
1. When a mother and child have the same genetic variant of HLA-DRB1, there is no guarantee that vertical transmission will occur; it just increases the likelihood.
2. When a mother and child have different variations of HLA-DRB1, there appears to be guaranteed protection from vertical transmission.

Unfortunately, a mother cannot control the similarity or dissimilarity of her infant's genetic construction. However, whenever a trial reveals a definitive link for Hepatitis C transmission, we gain some ground in understanding this virus. Undoubtedly, the more information gathered on how Hepatitis C is transmitted, infects people, replicates and dies, the closer we are - as a whole - to putting an end to this source of chronic liver disease.

Article by http://hepatitiscresearchandnewsupdates.blogspot.com



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What Is Primary Biliary Cirrhosis (PBC)?

Thank you Craig... I always know where to go to find good information. I met a man today (who is doing GREAT post-transplant) that needed a new liver due to PBC, which of course I had to find out more information about as soon as possible... so here it is!

Primary Biliary Cirrhosis (PBC) is a chronic liver disease that slowly destroys the bile ducts within the liver (intrahepatic bile ducts). Liver inflammation over a period of years may cause scarring which leads to cirrhosis. PBC is NOT alcohol or drug related, and it is NOT contagious. The name "Primary Biliary Cirrhosis" is somewhat deceiving since cirrhosis only occurs in the last stage of the disease (stage 4) after many years of inflammation. With early diagnosis and proper medications, most with PBC will never reach the cirrhosis stage of PBC. PBC is also called "Chronic Nonsuppurative Destructive Cholangitis" and "Primary Autoimmune Cholangitis." However, these alternative terms are not widely accepted and therefore not in use. Definition from New American Medical Dictionary: Primary: First in order of development, most important, arising spontaneously. Biliary: Relating to or affecting the bile duct system or bile. Cirrhosis: An inflammatory disease of the liver associated with the replacement of liver cells by fibrous tissue. Passage of blood through the liver may eventually be obstructed by the cirrhosis. The cause of PBC is still unknown, but it is not alcohol or drug induced. Current studies suggest it may involve autoimmunity, infection, or genetic predisposition, and does seem to appear more often in certain families. Women are affected 10 times more than men, and PBC is usually diagnosed in patients between the ages of 35 to 60 years. Those with PBC usually look extremely healthy, and many are 10 to 30 pounds overweight. The slight bronze pigmentation of the skin is often present in the advanced stage of the disease, and makes the individual look tanned. The outward appearances doesn't tell the story of what is going on inside their bodies. Even on the transplant list stage, many with PBC look healthy. A person with PBC commonly hears comments such as "you look so healthy or you don't look sick." Upon diagnosis, some doctors may suggest their patient start: Start a reduced sodium diet and or low fat diet. Nutrition In severely damaged livers, proteins may be restricted. Drink plenty of water and other fluids such as juice. Calcuim and Vitamin D. Calcium is the most common mineral in the body and is required for proper functioning of most organs. It is particularly needed in the normal development of the bones and teeth. Osteoporosis is a bone disease where calcium leaves the bones, causing them to weaken, and is commonly associated with PBC. Avoid or lower intake of alcohol Lower caffeine intake Avoid undue stress Exercise, if possible. Walking is the most common recommendation for exercise. Stop smoking The above suggestions have been found to be very helpful in liver disease, but are common sense considered part of healthy living. PBC Menus and meal plans by Norma J. Thiel, RD, Clinical Nutrition Manager Mountainview Hospital. The number of patients being diagnosed at the asymptomatic stage has risen dramatically over the past few years due to widespread laboratory screening. Typically, the blood lab pattern reveals an elevated alkaline phosphatase level with a normal bilirubin. Bilirubin does not increase until final disease stage. There are four disease stages of PBC. Medical tests used to confirm PBC: A liver biopsy helps confirms the diagnosis, but is not a requirement. Ultrasound exam may be performed to visualize the bile ducts to exclude an obstruction. Blood lab tests that show liver dysfunction: Liver function tests Antimitochondrial antibodies. Positive AMA is found in about 95% of PBC patients. Serum cholesterol and lipoproteins may be increased. Haptoglobin & ACE levels may be altered Diagnostic tests PBC advances slowly over a period of years. Most patients lead normal lives for years without symptoms, depending on how early diagnosis is made. There is no cure for PBC, but patients are showing good results in slowing the disease progress with URSO 250 , Actigall and methotrexate. With the current medications, it is becoming more common for the PBC patient to live a long life without any complications from PBC, and in some cases actually lowering the disease stage from original diagnosis stage. PBC is considered an autoimmune disease. Some diagnosed with PBC, may also be diagnosed with one or more other autoimmune diseases. Click for diseases and conditions associated with PBC. Most patients remain without symptoms for many years, and some may never notice any symptoms. The initial symptoms vary among PBC patients, and the varying symptoms can sometimes make it difficult for doctors to actually diagnose PBC. The varying symptoms may be do to the individual, autoimmune nature or other diseases associated with PBC. Symptoms may be present in any combination and include any of the following: Fatigue may be the first symptom the patient notices, causing him or her to visit their doctor. The fatigue associated with PBC appears to be totally different from any other sort of fatigue. In early stages, many patients have commented they could sleep for hours. While some in the later stages say sleeping becomes more difficult. At this time, there is little research into the cause and treatment of the liver disease fatigue. It is usually not due to depression, and some researchers believe it is an abnormality of the axis between the pituitary and the adrenal glands. Support and understanding from family members, friends and the doctor is very important, making it somewhat bearable. Intense and unrelenting itching of the skin. Gradual darkening (hyperpigmentation) or changes in skin texture, and various skin rashes. Small yellow or white bumps (xanthomas) under the skin, or around the eyes. Dry Eye Syndrome Dry mouth, sometimes referred to as cotton mouth. Thyroid problems Arthritic aches and pains in bones, muscles and joints are common. In some, the pains can be severe and debilitating. Some even report severe pain just touching leg, feet and hip bones, but this is NOT common. Over the years, as the PBC progresses, other symptoms may appear. These symptoms may include any of the following: Osteoporosis or other metabolic bone disease. See osteoporosis exercises. Enlarged abdomen from fluid accumulation. Easy bruising or bleeding Jaundice (yellowing of the skin and eyes) Increased bilirubin Internal bleeding in upper stomach and esophagus, that may be caused by varcies. Hepatic encephalopathy causing personality changes: dulling of mental functions, neglect of personal appearance, forgetfulness and trouble concentrating, changes in sleeping habits, confusion, breath odor and muscle stiffness. Encephalopathy occurs in final stage of PBC. Hypersplenism, enlarged spleen Fever, nausea and vomiting Reflux and stomach ulcers Weight increase or decrease Swelling of the hands, legs and ankles. See edema and ascites Sexual problems (impotence in men, absence of periods in women, lack of desire.) Trembling hands Difficulty in sleeping and changes in sleeping habits. Some PBC patients have noted that itching intensifies when they lay down to sleep, and those who have liver pain say it is more severe in a sleeping position. Hepatorenal syndrome, progressive deterioration of kidney function leading to kidney failure in a person with liver failure. Hepatopulmonary syndrome, associated with difficulty with breathing. Liver cancer (hepatocellular carcinoma) Abdominal pain or pressure in the liver area. (Yes it's real) As the PBC progresses, some patients require vitamin A, vitamin D, vitamin E and vitamin K replacement therapy to add back fat-soluble vitamins which are lost in fatty stools. A calcium supplement may be prescribed to help prevent osteomalacia and osteoporosis. When medical treatments, such as URSO 250 & URSO Forte, Actigall and methotrexate, no longer control the disease, the patient should be evaluated for a liver transplant. The end stage of PBC is liver failure. Many signs indicate liver failure: increased bilirubin, jaundice, fluid accumulation or ascites, malnutrition, gastrointestinal bleeding, intractable itching, bone fractures and hepatic coma. Transplant is recommended before most of these symptoms occur. Recent studies suggest that about 30% of those diagnosed with PBC will require a transplant. The transplant outcome for PBC patients is excellent. As with any other chronic illness, support and understanding is very important in helping the PBC patient cope with day to day living.

Author: CNL Created: 4/25/2010  Ref #:46546

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