HCV Advocate Logo HCV Advocate Logo
Contact Us Site Map Resources en Espanol
For living Positivley. Being Well
About Hepatitis
News Updates
News Review
Conference Reports
News Articles
HCV Advocate Newsletter
Sign up for Email Updates
Community & Support
Resource Library
About Hcsp
 
Learn how you can support HCSP and expand our mission to educate and support the HCV community as well as the general public.
Bookmark and Share
HCV Advocate Newsletter

Back to Newsletters

November 2010 HCV Advocate

Download printable version

--------

In This Issue:

Two Important Discoveries
Alan Franciscus, Editor-in-Chief

Disability & Benefits: It’s Open Enrollment Time Again
Jacques Chambers, CLU

HealthWise: Living Donation Liver Transplantation
Lucinda Porter, RN


HCV Snapshots
Lucinda Porter, RN
Alan Franciscus, Editor-in-Chief


HCV Advocate Eblast
Stay informed on the latest news ..click here to register for email alerts

Back to top


Two Important Discoveries
—Alan Franciscus, Editor-in-Chief

Two recent discoveries are greatly expanding our knowledge of the hepatitis C virus—the replication process and what happens when the virus passes the blood brain barrier.

HCV Replication Process
A recent discovery of the involvement of fat cells in the replication process of the hepatitis C virus promises to greatly expand our knowledge of the virus as well as provide us with information that may lead to the development of more medications to treat hepatitis C. 

Scientists at the Gladstone Institute identified a key enzyme that is involved in the production of lipid (fat) droplets—this enzyme is critical in the replication process of the hepatitis C virus. The enzyme, DGAT1, was discovered and cloned by the scientific team at the Gladstone Institute of Cardiovascular Disease. 

The replication process of the hepatitis C virus is fairly straight forward—the virus attaches to and enters the cell (mainly liver cells) and takes over the host cell machinery to make more copies of itself.  Once inside the cell HCV will shed its outer layer exposing its viral proteins which are then processed and replicated.  After replication the virus is released back into the bloodstream where it is transported to other cells to infect and replicate. The DGAT1 enzyme was found to be a critical part of the replication process.  The scientists were able to prove this: when the DGAT1 enzyme was inhibited it stopped the ability of the virus to replicate.  There are already DGAT1 inhibitors in clinical development to treat obesity.  The next step is to study the inhibitor in people with HCV to find out if it would in fact cure HCV.  

Source:  Gladstone Press Release www.gladstone.ucsf.edu

HCV and the Brain
“It’s not just the liver Stupid!”  Over the years science has proven that hepatitis C infects and affects many parts of the body—not just the liver.  It has also been known for some time now that the hepatitis C virus passes the blood-brain barrier to infect and replicate in the brain.   Just ask anyone with hepatitis C and you may just get a whole laundry list of cognitive problems that people with HCV experience on a daily basis.  These symptoms can include forgetfulness, inability to concentrate, etc.  The exact mechanism that causes these types of neurological problems, however, has so far eluded scientists.  That is until now—scientists at University of Alberta Research were able to prove that the hepatitis C virus causes inflammation in the brain, damages certain brain neurons, and prevents a key process in the brain that rids itself of these types of toxins.    

These findings prove and explain why some people infected with hepatitis C have neurological symptoms.  More importantly the finding will hopefully help to pave the way for medications to treat these types of symptoms. 

Source:  University of Alberta Research
http://www.research.ualberta.ca/


Back to top


Disability & Benefits: It’s Open Enrollment Time Again
—Jacques Chambers, CLU

This is the time of year when many employers provide an Open Enrollment Period for employees, allowing them to make changes in their employee benefits choices. Although employers can select other times of the year for this, the majority of employers have their Open Enrollment in November and/or December for a January 1, 2011 effective date.

Also, from November 15 through December 31 Medicare beneficiaries are able to make changes in their coverages as well.  NOTE: Later in this article important changes in health plans and Medicare as a result of the new Healthcare Reform Act are described.

Employer Provided Benefit Plans
Companies offering an Open Enrollment period will publish (or offer online) an Open Enrollment Guide that spells out each employee’s current benefits plus the available change options, opportunities, and costs that may be made during the period.  For persons dealing with a serious medical condition like HBV/HCV, it can be an opportunity to alter benefits and, in some cases, actually increase benefits.

Life Insurance. Persons dealing with HBV/HCV are generally unable to purchase life insurance in the individual market. However, some larger employers offer voluntary, supplemental life insurance and open enrollment may offer an opportunity to increase the amount of life insurance an employee purchases without proof of good health. Often, the amount that can be increased without providing such proof is limited to only the next immediate bracket if available.

An employer may give all employees a base benefit from $10,000 to $50,000 or more. In addition they may offer Supplemental Life Insurance in certain increments on a guaranteed issue basis up to a specified maximum that the employee would pay for through payroll deduction.

Many employers will allow employees, at Open Enrollment, the opportunity of increasing their life insurance by one increment, again without requiring proof of good health. This would give you the opportunity of increasing your life insurance benefits at a low cost.

While some employers offer this option, many others will not. If it is available, it is an excellent way for an otherwise “uninsurable” person to obtain additional life insurance.

Long Term Disability. Less common, but still occasionally available, is the opportunity to increase the benefit of your LTD plan. Some employers will provide a basic benefit for LTD, such as 50% or 60% of your monthly earnings, and allow employees to purchase an additional 10% or 15% to raise the benefit they would receive in the event of disability.

Some employers may allow you to add this benefit if you did not select it originally. Again, it is important to read your Open Enrollment material to see if your employer offers this.

Revising LTD Premium Payment. One additional possibility to explore is the payment of LTD premiums and its effect on the income taxability of the disability benefits should you ever need to collect them. Some employers will allow you to pay for the LTD coverage through payroll deduction rather than receiving it as a gift. If this is possible you may want to jump at the chance, the reason being taxes.

If you pay for the LTD coverage with money you pay income taxes on, then the benefits you receive if you become disabled will be income tax free, substantially increasing the spendable dollars you would receive as a disability benefit.

Conversely, if the employer “gives” you LTD coverage and pays for it as part of his business expenses, then any benefits you would receive upon disability are fully income taxable. The key is: if the cost of LTD coverage is included in the W-2 you receive at the end of the year, then the benefits, when you collect them, will not be income taxable.

Health Related Benefits. Many employers, especially larger ones, offer a variety of health, dental, and vision plans from which employees can choose. At Open Enrollment you have the opportunity to change your coverage from one plan to another regardless of your medical condition, and sometimes have the opportunity to make choices within your plan, such as increase or decrease the size of the deductible.

For someone dealing with HBV/HCV, this can be an important choice, especially if this is the first Open Enrollment since diagnosis. There is no one type of health plan that is best for everyone. There are two main kinds of plans that employers often offer:

  • Preferred Provider Organization – These plans provide some coverage for all physicians, but pay more if you choose a physician that has contracted with the insurance company, a Participating Provider. This plan will give you the greatest flexibility in medical providers; however, it will often cost you more out of pocket for both your portion of the monthly premium as well as the plan co-pays and co-insurance.
  • Health Maintenance Organizations – These plans usually offer the lowest out-of-pocket expenses, but limit your choice of physician. Coverage is only provided when using one of their contracting doctors and hospitals. Also, a Primary Care Physician (also called a Gatekeeper) oversees all your medical care and must refer you to a specialist before the HMO will cover the specialist’s charge.

Which plan is better for you will depend on what doctors you wish to retain and what HMOs or PPO plans they are part of, as well as the cost to you.

Important Changes: Under the new Affordable Healthcare Act (ACA, also called the Health Reform Act), the following changes must be made at the beginning of each employer’s plan year, except for certain “grandfathered” plans:

  • Lifetime limits on benefits are prohibited.
  • Children must be allowed to remain on their parents’ policy up to age 26, even if no longer dependent.
  • Preventive services (physical exams, diagnostic screening exams, etc.) must be covered 100% with no deductible, as long as they are provided by In-Network Providers.

Each employer and its insurer will have rules as to what may and may not be added or changed, so be sure to read the Open Enrollment Guide carefully. Some of the possible changes are listed below.

Medicare
Medicare beneficiaries have several choices as well, and the choices must be made between November 15 and December 31 with all changes effective January 1, 2011.

Original Fee For Service Medicare – Many people elect to stay with original Fee-For-Service Medicare. It consists of Part A – Hospital Coverage; Part B – Medical Coverage; and Part D – Prescription Drug Coverage. Parts A and B of original Medicare are the same for everyone, however, each beneficiary can elect in which prescription drug plan to enroll.

The only way to determine which Drug Plan is best for you is to compare plans using your own prescriptions, since not all plans cover all medications. There is a program on line at www.medicare.gov that allows you to enter your medications and where you live and it will show you what each plan would cost you out of your pocket based on your medications. Even if your current Drug Plan has been serving you well, it is advisable to re-run the program in case your medications have changed or your drug plan is revising its formulary for the coming year. The plans for 2011 are already up on the website.

For persons who are not comfortable with computers, Medicare’s toll-free number (800-MEDICARE) will do the same calculation. However, I recommend you find a friend or relative who will do it for you, because the results are too long and involved for a telephone operator to spend much time reviewing all options.  

Medicare Advantage Plans – These are plans offered by insurance companies and health service providers that are an alternative to Fee-for-Service Medicare. Many of these plans are Health Maintenance Organizations, but there are also Preferred Provider Organization Plans, Special Needs Programs, and Private Fee for Service plans, although all types are not available in all states.

Under these plans, Medicare pays the insurance company to provide all of your medical care. Benefits under your red, white, and blue Medicare card are no longer covered directly, but the Medicare Advantage Plan must offer all of its benefits and may add more. Some plans may also charge an additional premium, usually relatively small. These plans also include the prescription drug coverage in their plan so you don’t have to work through the Part D coverage question.

Important Change: Under the new Affordable Healthcare Act, all Medicare Advantage plans must limit the claimant’s out-of-pocket expenses to no more than $6,700 per year.

During this Open Enrollment Period, persons may switch from one Medicare Advantage Plan to another or move back to or away from Fee-For Service Medicare.

All changes made to Medicare take effect on January 1.

Important Change: The enrollment period from January 1 through March 31 when one could change from one Medicare Advantage to another is eliminated. In its place is a Disenrollment Period: from January 1 through February 14, one can leave a Medicare Advantage Plan and move to Original Fee-for-Service Medicare and also have a Special Enrollment Period to add Prescription Drug Coverage.

Also, for persons who did not enroll in Medicare Part B when it was first available and who do not qualify for a Special Enrollment Period, there is a General Enrollment Period between January 1 and March 31 of each year with the Part B coverage taking effect the following July 1. There will usually be a surcharge to the premium of 10% for each year you could have been in Part B but were not.


Back to top


Healthwise: Living Donation Liver Transplantation
—Lucinda K. Porter, RN

Thanksgiving is traditionally a time to take stock of our blessings, and this year I am especially grateful for the extreme generosity of one of my stepsons. This fall he donated a kidney to his sister-in-law.  They weren’t especially close, but her tenuous hold on life moved him to want to help. Now she is dialysis-free and reclaiming her life.

As my family gathered around this transplant, I became immersed in the topic of living donation. Because I live with and write about chronic hepatitis C virus infection (HCV), I was curious about the issue from the perspective of the living liver donor. (Try saying lively living liver donor ten times fast.)

According to the Organ Procurement and Transplant Network (OPTN), there are 16,000 patients on the liver transplant waiting list. HCV is the most common reason that people are listed. The number of livers that are donated is lower than the need, so a small percentage of patients die before they receive a transplant.

Live organ donation provides more livers to help fill this need. However, living liver donation is a complicated prospect, filled with risk and ethical issues. A few donors have died from post-surgical complications. It is hard to reconcile putting a healthy person’s life at risk, even for a noble cause.

This year, two donors have died from complications related to liver donation, one was at Boston’s Lahey Clinic in Boston; the other was at the University of Colorado Hospital in Aurora. Both deaths were of men who had donated to relatives.

The first live organ donation occurred in 1954; the first live liver donation was in 1989. There have been more than 4100 liver transplants using organs from living donors, which is less than one half of a percent (0.05%) of all liver transplants. The vast majority of live liver donors are relatives of the transplant recipients. In the twenty year history of living liver transplantation, 36 livers were donated anonymously. This graciousness touches my heart and warms my hepatic vessels.

We can’t survive without a liver, so you may wonder how a healthy human could donate. The answer lies in the liver’s amazing powers of regeneration. Live donor transplantation uses only a part of the liver. After the surgery, the donor’s liver returns to 90 to 100% of its original size in about 2 months. The same is true for the recipient—in about two months, the donated liver regenerates to its needed size. If the recipient is a child, the liver segment will grow with the child.

Transplanting a liver from a living donor is a major surgical procedure. The operation is about 4 hours for the donor; 4 to 6 hours for the recipient. To remove the liver, the surgeon makes a large incision in the chest and spreads the ribs with an instrument called a retractor.  The incision is a large three-pronged cut, leaving what patients often refer to as a Mercedes-Benz scar. 

Guidelines for the medical evaluation of living liver donors were established in 2006. Potential donors need to be between 18 and 60 years of age and must meet certain criteria. They cannot have the following:

  • Diabetes
  • Significant history of thrombosis or embolism 
  • Bleeding disorders
  • Uncontrollable psychiatric illness
  • Morbid obesity
  • Clinically significant coronary and/or peripheral vascular artery disease
  • Symptomatic valvular disease
  • Chronic lung disease with impairment of oxygenation or ventilation
  • Recent malignancy or cancers with long times to recurrence (e.g., breast cancer)
  • Abnormalities in the donor liver that make the likelihood of successful transplantation low or increase the risk in the potential donor
  • Viral hepatitis or certain other viruses
  • Fatty liver disease
  • Multiple or complex upper abdominal surgeries

There are other criteria, which potential donors will be screened for during the evaluation process. The evaluation process includes extensive medical and psychosocial components.
According to the publication, Guidance for the Medical Evaluation of Potential Living Liver Donors by the Organ Procurement and Transplantation Network (OPTN), there are risks for living liver donors. About 1 in 3 donors will have some sort of complication, either minor or severe; approximately 95% of these complications are minor. The risks include:

  • Anesthesia risks
  • Surgical complications such as liver failure, blood loss, bile leak, blood clots, infection, pain, hernia
  • Death – The estimated probability of donor death is between 1 in 500 to 1 in 1000

OPTN reports “that 5 out of 3632 (0.1%) living liver donors were subsequently listed for liver transplant between 4/1/1994 and 11/30/2008. All living liver donors were placed on the liver transplant waiting list within 20 days after donation. One living donor died after being placed on waiting list, three candidates received deceased donor liver transplants within 4 days after listing, and one candidate was removed from the waiting list due to improved health.” 1

Even the medical evaluation involves some risks. If a liver biopsy is performed, there are the usual risks associated with this procedure; the same is true for blood draws for laboratory testing and other diagnostic procedures. Potential donors may have an allergic reaction to some of the dyes used during abdominal imaging studies. There is the risk that another disease will be uncovered, although if something is detected early because of the evaluation, this could be beneficial to the potential donor. If the disease is something such as HIV that must be reported to the local health agency, this may bring unexpected consequences.

Another risk is that tests may uncover family secrets. An adult child may discover that the father he wanted to donate an organ to is not his biological parent. This can lead to a cascade of events beyond what anyone could predict.

When a potential donor steps forward, it may surprise them to discover that their intended liver may not be as healthy as expected. At a poster session of the 2006 American Association for the Study of Liver Diseases, Savas and colleagues evaluated the health of the livers of potential living donors. In Histological Abnormalities Found on Liver Biopsies of Apparently Healthy Potential Liver Donors, they examined 305 subjects who had healthy livers after preliminary medical and laboratory exam. After further testing, over 100 were eliminated, leaving 201 left whose livers appeared to be healthy. Liver biopsies were performed and nearly half of the organs had some sort of tissue damage, such as inflammation or fat accumulation.

There may be financial risks or hardship to the donor. In some cases, life insurance policies may be denied or canceled, so this needs to be checked out prior to donation. If donation presents a financial hardship for the donor, there are funds for those who qualify. For more information, see the link at the end of this article for National Living Donor Assistance.

If you or someone you know is considering living organ donation, spend time researching the various transplant programs. Even transplant centers that have experienced a death of one of the donors may still be a good choice if they have performed many of these procedures. Transplant centers keep records of their success rates and you have the right to this information.

Whether you are on the liver transplant list or not, Thanksgiving is a dangerous place for liver cells.  It is not enough to count our blessings during these festive high-fat feast holidays; we also have to watch our food intake. After saying thank you for the blessing I received this year, I will say no thanks to alcohol and too much gravy. I will serve healthy food, because I want my family to stay healthy. I never know when I might need to ask one of them if they want to spare part of a liver. 

Resources:

Endnote:
1Guidance for the Medical Evaluation of Potential Living Liver Donors, Organ Procurement and Transplantation Network.


Back to top


HCV Snapshots
—Lucinda K. Porter, RN
Alan Franciscus, Editor-in-Chief

Article: Tattooing and the Risk of Transmission of Hepatitis C: A Systematic Review and Meta-Analysis by Siavash Jafarib, Ray Copesa, Souzan Baharlouc, Mahyar Etminand, Jane Buxtona
Source: International Journal of Infectious Diseases published online August 3, 2010

The authors of this paper searched all available medical literature to establish if tattooing is a risk factor for hepatitis C virus (HCV) transmission.  They found 124 studies published before November 2008 and used 83 studies from 30 countries for their final analysis. Based on their findings, the authors concluded:

  • Overall, those with tattoos have nearly a three times higher risk of having HCV compared to those without tattoos.
  • The odds of having HCV are nearly 6 times higher in non-injection drug users who have tattoos compared to non-injection users without tattoos.
  • Tattoos are associated with a higher risk of having HCV for multiple subsets of the population, including blood donors, injection drug users, and high risk populations.
  • Blood samples from hospitals, prisons, and communities showed an increased risk of HCV among those with tattoos as compared to those without tattoos.

The Bottom Line: Tattooing potentially involves blood-to-blood contact. We need tattooing guidelines that focus on infection prevention. Education about safer tattooing practices is also needed, targeting young people, those in prison, and other high risk populations.

Editorial Comment: The authors of this research are aware that their findings are based on observation and analysis.  Although there is an association between tattooing and HCV, that does not mean that tattooing causes HCV.  For instance, there are no data showing differences in those who were tattooed in professional salons versus in prisons. It would be interesting to look at the differences between non-injection users who received tattoos in prison versus those who were tattooed professionally. Since a causal relationship between tattooing and HCV transmission cannot be firmly established, further studies are warranted. 

Article: Risk Factors for Infection during Treatment with Peginterferon Alfa and Ribavirin for Chronic Hepatitis C by Robert Roomer, Bettina E. Hansen, Harry L. A. Janssen, Robert J. de Kneg
Source: Hepatology October 2010; Volume 52, Issue 4, pages 1225–1231

A drop in white blood cells (neutropenia) is a common side effect from the medications used to treat hepatitis C virus (HCV) infection. In certain circumstances, neutropenia may create a potentially life-threatening condition, particularly for cancer patients. Since neutropenia is associated with infection risk, dose reduction of interferon is routinely advised when HCV patients have a dramatic drop in white blood cells. However, it has long been observed that HCV patients with neutropenia are not necessarily vulnerable to infection and since, theoretically, interferon stimulates the immune system, the practice of dose reduction is not based on sound evidence. This study looks at the relationship between infection and neutropenia in HCV treatment patients. 

The researchers studied 321 patients who visited a single-center for a total of 2,876 visits. All HCV patients were treated with peginterferon alfa and ribavirin, and their absolute neutrophil count (ANC) was observed. A normal ANC is > 1500 cells/µL, but some people have naturally low ANC ranges, particularly those of African-American descent. In this study, patients started with an average ANC of 3,420 cells/µL; 5% had a baseline ANC of <1,500 cells/µL.

Dose reduction of peginterferon is advised when ANC drops below 750 cells/µL; medication discontinuation occurs when ANC is below 500 cells/µL. In this study, an ANC <750 cells/µL was noted in approximately 30% of patients during HCV treatment; 5% had an ANC of <375/µL. Nearly 22% of all patients were diagnosed with infections, 13.5% were defined as severe. However, infections did not correlate with neutropenia during treatment and dose reductions did not lead to a decrease in infection rate. Older patients and those with uncontrolled diabetes were at greater risk for infection.

The Bottom Line: Neutropenia from peginterferon and ribavirin is not associated with increased risk of bacterial infection. 

Editorial Comment:  A drop in white blood cells can be frightening to observe, for both patient and medical providers, particularly if they are inexperienced with this phenomenon. On top of this, the guidelines for dose reduction or discontinuation due to neutropenia are clearly printed in the prescribing information that accompanies HCV medications. However, dose reduction may diminish one’s chances of responding to treatment. Studies such as these will help us increase our chances of responding to treatment while focusing on patient safety. 

It would have been interesting to compare the rate of infection of this population to people who were not undergoing HCV treatment but attending the same center for other reasons.

Article: Use of Statins in Patients with Chronic Hepatitis C by Miranda R. Andrus and Jessica East
Source: Southern Medical Journal October 2010; Volume 103, Issue 10, pages 1018-24

Statins are a group of medications used to decrease cardiac risk by lowering cholesterol. Statins may elevate liver enzymes and are not advised for patients with liver disease. However, research has shown that patients with chronic hepatitis C virus infection (HCV) have an increased risk of cardiovascular disease. This study looks at the use of statins for HCV patients.

The study design was a prospective, randomized, double-blind, placebo-controlled, parallel-group trial looking at efficacy and safety of a high dose of pravastatin (80 mg daily). All patients had high cholesterol and well-compensated liver disease. There were 326 liver disease patients of whom 62% were diagnosed with varying degrees of fatty liver; 27% were HCV-positive.

Patient safety was measured by an increase in liver enzymes (ALT) ≥2 times the upper limit of normal for those with a normal ALT at baseline, or a doubling of the baseline ALT in those who had an increased ALT at baseline. Fewer patients in the pravastatin group experienced ALT elevations compared to the placebo group. Both groups had similar sustained elevations of ALT and side effects. No patient had an acute worsening of liver disease during the study.

The Bottom Line: There is no clinical evidence against the use of statins for HCV patients, and they may be beneficial for those with chronic, stable HCV at increased cardiac risk or with a history of heart disease. Until there is more research, patients with advanced end-stage liver disease are advised to avoid statins.

Editorial Comment: This study is similar to the previous study about neutropenia in that it shows that until we have solid evidence, we tend to apply broad generalizations from one area to another. For example, oranges are a fruit and they are sweet. Lemons are a fruit, so logically they must be sweet. We know this isn’t true, but we also know that there are sour oranges and sweet lemons. In medicine, since the health of patients is a stake, it is better to err on the side of caution; if there is no evidence to support that statins won’t harm HCV patients, it is better to avoid these drugs. Do no harm is the medical code.

Article: Liver Allografts from Hepatitis C Positive Donors Can Offer Good Outcomes in Hepatitis C Positive Recipients: A US National Transplant Registry Analysis by Patrick G. Northup, Curtis K. Argo, Dennis T. Nguyen, Maureen A. McBride, Sean C. Kumer, Timothy M. Schmitt, Timothy L. Pruett
Source: Transplant International October 2010; Volume 223, Issue 10, pages 1038-1044

Just like blood donation, organs that are donated for transplantation are screened for evidence of hepatitis C virus (HCV). If an organ tests positive for HCV antibody (anti-HCV+), it may be used for anti-HCV+ recipients on the liver transplant list. This study looked at the long-term outcomes of anti-HCV+ patients who were transplanted with anti-HCV+ livers.

Using the registry of the US Organ Procurement and Transplantation Network, this research analyzed data from 56, 275 liver transplants from 1995-2008. There were 19,496 anti-HCV+ recipients and 934 anti-HCV+ donors.

The Bottom Line: The death rate of the anti-HCV-negative recipients who received anti-HCV-negative livers was similar to the death rate of the anti-HCV+ transplant recipients who received anti-HCV+ livers.  

Food for Thought: From a practical standpoint, this suggests yet another benefit of HCV treatment. We know that patients who have a sustained response to treatment are unlikely to need an HCV-related liver transplant. If they clear HCV, does this mean that their livers may be eligible for donation upon death? Research and time will tell.

Article:  Predictive Factors for Response to Peginterferon-Alpha and Ribavirin Treatment of Chronic HCV Infection in Patients Aged 65 Years and More by Giannini EG, Basso M, Savarino V, Picciotto A. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, no. 6, 16132, Genoa, Italy
Source:  Dig Dis Sci. 2010 Sep 18. [Epub ahead of print]

Information about treatment of people with HCV who are aged 65 and older is practically non-existent. 

Fifty-seven HCV patients who were treated with pegylated interferon and ribavirin were included in the study.  The aim of the current study was to identify the pre- and on-treatment predictors of treatment response in people 65 years old and older.  The information collected on the patients included patient demographics, genotype, biochemical, clinical and viral load information prior to treatment. 

It was found that 45% (25 patients) achieved an SVR.  The only pre-treatment predictor of achieving an SVR was HCV genotype 2 and 3, which is in line with what we already know about the higher success rates in people infected with HCV genotypes 2 and 3.  Another known predictor is being HCV RNA or viral load negative at week 12.  In this regard the authors found that 100% of the patients who were HCV RNA or viral load positive at week 12 did not achieve an SVR.  An interesting but not too surprising finding was that 10 patients (17%) discontinued treatment due to heart problems—heart problems are more common in people over 65 years old.

The Bottom Line: The SVR rates and general predictors of treatment response observed in the study are comparable to those found in the general HCV population.  As more of the HCV population ages and seeks medical care and treatment it is going to be even more important that people are carefully monitored to prevent any serious complications such as the heart problems noted in this study.

Clinical trials in the HCV population over 65 years old are sadly lacking.  As more and more drugs are being identified and studied to treat hepatitis C it is extremely important that people with HCV who are over 60 years old are included in clinical trials because the ‘Baby-Boomer’ HCV population is aging, and people over 60 years old will soon comprise the largest group of people infected with hepatitis C.  Unless we take immediate steps to study this underrepresented population, it could develop into the largest unmet medical need in the hepatitis C population.   

Food for thought: I’ve heard some medical providers remark that many people with hepatitis C who are over 60 years old will not seek treatment with HCV medications.  However, I hear a different story when I talk with people over 60 yo who mostly remark that their medical provider, family and friends discouraged them from seeking treatment.  The reasons given by people with HCV for seeking treatment are the same as anyone with HCV—getting cured and improving symptoms and quality of life; but the most often voiced reason is that they want to live to a ripe old healthy age.  What do you think—if you were or are over 60 yo would you seek treatment?

 

Be Sure to Check Out Our Streaming Videos:

  • Top-Line Phase III Data: Boceprevir & Telaprevir (Video & Slide Presentation)
  • Kelly Zirbes of “Kelly’s Lot” on Stigma
  • Taking Care — Documentary on hepatitis C
  • Release Relapse — Documentary on opiate addictions 
  • Living with Hepatitis C — Available in English, Spanish and Portuguese
  • Getting Through: Stories of HIV/Hepatitis C Co-Infection
  • An Interview with Dr. Mark Sulkowski — Video on Treatment of Hepatitis C in Co-infected Individuals Intended for Health Care Providers

www.hcvadvocate.org/hepatitis/
training_resources.asp



Back to top

Back to Newsletters


About Hepatitis | News Updates | Community & Support | Resource Library | About HCSP | Contact Us | Site Map | Recursos en Español | Home

Hepatitis C Support Project

© 2010 Hepatitis C Support Project
a project of the Tides Center


Medical  Writers' Circle
Fact Sheets