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December 2011 HCV Advocate

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In This Issue:

HCV Snapshots: A Summary of AASLD 2011
Alan Franciscus, Editor-in-Chief


HealthWise: Free from Hepatitis C
Lucinda K. Porter, RN


Book Review: Free from Hepatitis C
Rose Christensen


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HCV Snapshots: A Summary of AASLD 2011
—Alan Franciscus, Editor-in-Chief

The 2011 meeting of the American Association for the Study of Liver Diseases is an important event for patients with chronic hepatitis C virus (HCV) infection and other liver diseases.  This year, Alan Franciscus (AF) and Lucinda K. Porter, RN (LKP) provide highlights on some of the presentations and posters.

Important note:The research results presented here are gathered from conference posters, presentations and abstracts.  They represent part of the story, particularly data presented about current HCV medications and medications being developed to treat hepatitis C.  There are many factors that influence treatment outcomes such as the number of patients in the study, and the patient demographics (genotypes including subtypes, age, placebo vs. open label, ethnicity, etc.) to name a few.  Unless and until these studies are published in a peer-reviewed journal, these data and conclusions are considered preliminary.

For more information about these and other presentations, go to click here.

Abbreviations:  TID (three times a day); BID (two times a day); QD (once-a-day); pegylated interferon (PEG); ribavirin (RBV); GT (genotype); RVR (rapid virological response).

 

 

Drugs in Development:  Direct Acting Antivirals (DAA’s)

 

Program #34:  Once Daily PSI-7977 plus RBV: Pegylated Interferon-ALFA Not Required for Complete Rapid Viral Response in Treatment-naïve Patients with HCV GT2 or GT3.

Lead Author: Edward Gane, et al.

Clinical Development:  PSI-7977 will commence Phase 3 studies at the end of 2011 or beginning of 2012.  PSI-7977 (QD) is an HCV polymerase inhibitor.

Results and Conclusion:  This is a study of 40 genotype 2/3 subjects using PSI-7977 (a nucleotide analog) with ribavirin with and without peginterferon.  This has an elaborate study design using IL28B testing, and assignment to treatment arms based on those results.  All 10 subjects in the arm receiving PSI-7977/RBV without peginterferon achieved an RVR by week 4, with no evidence of resistance.  SVR12 results found 100% cure rates across all treatment arms including the interferon-free arms. 

Editorial Comments: This is a small study with interim data, so it is unwise to draw conclusions at this time.  However, this was one of the most talked about presentations at the Liver Meeting, and it is hard not to get excited about this, especially when considering the next abstract (#225). (LKP)

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Program #225:  Once Daily PSI-7977 plus PEG/RBV in Treatment-naïve Patients with HCV GT1: Robust End of Treatment Rates are Sustained Post-treatment.

Lead Author: Eric Lowitz, et al.

Results and Conclusion: This phase 2B study using PSI-7977 plus PEG/RBV enrolled treatment-naïve patients with HCV GT1:  48 subjects received 200 mg/day PSI7977/PEG/RBV, 47 subjects received 400 mg/day PSI7977/PEG/RBV; 26 received PG/RBV.  At the oral presentation of this study, response rates better than 90% were reported for the arm using 400 mg/day PSI7977/PEG/RBV.

Editorial Comments: These are impressive data, but best to wait for these to be confirmed and in print. (LKP)

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Program #227:   Daclatasvir (DCV; BMS-790052), an NS5A Replication Complex Inhibitor, Combined With Peginterferon-Alfa-2a and Ribavirin in Treatment-Naive HCV-Genotype 1 or 4 Subjects: Phase 2b COMMAND-1 Study Interim Week 24 Results.

Lead Author: C Hézode, et al.

Clinical Development:  Daclatasvir (QD) is an HCV NS5A inhibitor in Phase 3.

Results and Conclusion: 395 HCV genotype 1 and 4 treatment-naïve patients were treated with a combination of daclatasvir and PEG/RBV; by treatment week 12 the following percentage of patients were HCV RNA undetectable:  genotype 1: 54% in the 20 mg and 60 mg groups (158 out of 293 patients) compared to 14% in the placebo group (10 out of 72 patients); genotype 4: 58% (7 out of 12 patients) and 100% (12 out of 12 patients) in the 20 and 60 mg groups respectively, compared to 50% (3 out of 6 patients) in the placebo group.  The medications were generally well-tolerated and the treatment discontinuations due to adverse events were similar across the arms including the placebo arm.

Editorial Comments:  The efficacy and safety profiles of daclatasvir are very promising.  The combination of daclatasvir plus PEG/RBV entered into Phase 3 studies this year.  The final results from the Phase 3 will give us a better picture of how well this drug works. (AF)

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Program #LB-4:  Dual Oral Combination Therapy with the NS5A Inhibitor Daclatasvir (DCV; BMS-790052) and the NS3 Protease Inhibitor Asunaprevir (ASV; BMS-650032) Achieved 90% Sustained Virologic Response (SVR12) in Japanese HCV Genotype 1b-Infected Null Responders.

Lead Author:  K. Chayama, et. al.

Clinical Development: Daclatasvir (QD) (NS5A inhibitor) is in Phase III; asunaprevir (BID) (HCV protease inhibitor) is in Phase II.

Results and Conclusion:  Ten HCV genotype 1b prior null-responders to a previous course of PEG/RBV were treated with daclatasvir in combination with asunaprevir (without PEG/RBV) for 24 weeks.  Nine patients completed therapy.  One patient discontinued therapy at week 2 due to a serious adverse event.  At 12 weeks post treatment 90% were cured.  The one patient who discontinued treatment at week 2 due to a serious adverse event was also cured. 

Editorial Comments:  This very small Japanese study is important for two reasons:  1) the high cure rates with two direct acting antivirals (DAAs) and without the aid of PEG/RBV, and 2) the patients treated in this study are considered the most difficult to treat – prior null-responders.  Hopefully, larger trials with more patients will show similar results in treatment-naïve and treatment-experienced patients.  (AF)

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Program #1329:  TMC435 in Combination with Peginterferon and Ribavirin in Treatment-Naïve HCV Genotype 1 Patients: Final Analysis of the PILLAR Phase IIB Study.

Lead Author: Michael Fried, et al.

Clinical Development:  Phase 3 studies began in early 2011.  TMC435 (QD) is an HCV protease inhibitor.

Results and Conclusion:  This study compared doses and duration of 5 study arms using peginterferon and ribavirin (PEG/RBV) with a protease inhibitor, TMC435; one arm received PEG/RBV plus placebo.  Patients receiving TMC435/PEG/RBV had significantly higher response rates than those in the control group.  The best response rates ranged from 68-76% at the higher dose of TMC435 (150 mg); 24 weeks of treatment was sufficient for most subjects.

Editorial Comments:  It will be interesting to look at Phase 3 results.  With shorter treatment lengths, data will be available earlier. (LKP)

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Program #LB-15:  Virologic response to an interferon-free regimen of BI-201335 and BI-207127, with and without ribavirin, in treatment-naïve patients with chronic genotype-1 HCV infection: Week 12 interim results of the SOUND-C2 study.

Lead Author: Stefan Zeuzem, et al.

Clinical Development: BI-201335 (QD) (HCV protease inhibitor) is in Phase 3 and BI-207127 (BID or TID) (HCV polymerase inhibitor) is in Phase 2.

Results and Conclusion:  362 HCV genotype 1 treatment-naïve patients were treated with a combination of BI-201335 (QD) and BI-207127 (BID or TID), with and without ribavirin (no interferon).  There are 5 treatment arms and treatment duration is 16, 28, or 48 weeks.  The interim 12 week results from 238 patients (combined arms) 57% (no ribavirin arm) to 76% (ribavirin arm) were HCV RNA below the lower limit of quantifications (<25 IU/mL).  The side effects were mild or moderate.  The treatment discontinuation rate due to adverse events was 6 to 12%. 

Editorial Comments:  The interim results from this BI combination interferon-free study showed very good early response rate in both the BI arms with and without ribavirin in a relatively large patient population that help to validate these encouraging results.   (AF)

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Program # 249:  High SVR following IFN-free treatment of chronic HCV GT1 infection for 4 weeks with HCV protease inhibitor BI-201335, polymerase inhibitor BI-207127 and ribavirin, followed by BI 201335 and PegIFN/ribavirin — the SOUND-C1 study.

Lead Author: Stefan Zeuzem, et al.

Clinical Development:  BI-201335 (QD) (HCV protease inhibitor) is in Phase 3 and BI-207127 (BID or TID)  (HCV polymerase inhibitor) is in Phase 2.

Results and Conclusion:  There were 4 treatment arms with different drug doses.  32 HCV genotype 1 patients were treated with a combination of RBV with BI-207127 (400 or 600 mg) TID and BI-201335 QD for 4 weeks followed by BI-2012335 QD plus PEG/RBV for 20 weeks followed by an additional 24 weeks of PEG/RBV.   SVR or viral cure rates were 73 to 94%.  The side effect profile was similar between the drugs in the interferon-free period compared to the side effects seen in the group that received BI-201335 plus PEG/RBV through the end of the study. 

Editorial Comments:  This small study provides more data to support the eventual use of interferon-free HCV treatment.  (AF)

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Program #79:   High sustained virologic response (SVR24) rates with response-guided danoprevir (DNV; RG7227) plus PegIFN a-2a (40KD) and ribavirin (P/R) in treatment-naive HCV genotype 1 (G1) patients: results from the ATLAS study.

Lead Author: Norah Terrault, et al.

Clinical Development: Danoprevir (BID) (HCV protease inhibitor) is in Phase 2.

Results and Conclusion:  405 HCV genotype 1 treatment-naïve patients received various doses (50 to 200 mg BID) of danoprevir (boosted with ritonavir) plus PEG/RBV; they were treated for 24 weeks and up to 85% achieved a viral cure 24 weeks after treatment ended compared to 42% in the group that did not receive danoprevir.  There were no new safety issues and a low rate of viral breakthrough (4.8%). 

Editorial Comments:  This is an important study because there were a large number of patients (> 400 pts) included in the study and the addition of danoprevir resulted in an increased cure rate of up to 60% compared to the group that received PEG/RBV with no danoprevir.  (AF)

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Program #346:  Safety and Antiviral Activity of MK-5172, a Next Generation HCV NS3/4a Protease Inhibitor with a Broad HCV Genotypic Activity Spectrum and Potent Activity Against Known Resistance Mutants, in Genotype 1 and 3 HCV-Infected Patients.

Lead Author: Amelia S. Petry, et al.

Clinical Development: MK-5172 (QD) (HCV protease inhibitor) is in Phase 2.

Results and Conclusion:  MK-5172 was given in doses of 50 to 800 mg QD (monotherapy) to males with 48 HCV genotype 1 and 30 HCV genotype 3 patients for 7 days.  There were 6 arms (including a placebo arm).  The maximum change in HCV levels was up to a decrease of -5.37 in HCV genotype 1 and -4.41 in genotype 3 patients.  In the genotype 1 patients 75% (30 out of 40 pts) were below the level of HCV RNA quantification (25 IU/mL).  The drug was generally well-tolerated. 

Editorial Comments:  Early stage studies of MK-5172 in various doses has been shown to work across different genotypes and can be dosed once-daily that makes it an attractive candidate for future clinical development.  (AF)

 

Drugs in Development:  General

Program #LB11:   Once-daily alisporivir interferon (IFN)-free regimens achieve high rates of early HCV clearance in previously untreated patients with HCV genotype (G) 2 or 3.

Lead Author:  JM Pawlotsky, et al.

Clinical Development:  Alisporivir currently in Phase 3.  Alisporivir (QD) is a cyclophilin inhibitor. 

Results and Conclusion: 340 Treatment-naïve HCV genotype 2 and 3 subjects were treated with alisporivir 600 to 1000 mg QD with and without interferon and/or ribavirin.  Up to 49% of patients in the interferon-free arms were HCV RNA undetectable by week 6 and the interferon-free regimes continued to remain HCV undetectable at week 12.  In addition the response rates were similar between genotype 2 and 3.

Editorial Comments:  The results from this large Phase 2 study are preliminary, but they do offer hope that alisporivir may offer an interferon-free regime for people with HCV genotype 2 and 3.  The other advantage of alisporivir is that is has a very low rate of drug resistance—at least in the trials conducted to date.  (AF)

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Program #1344:   Safety and Efficacy of Peginterferon Lambda-1a (Lambda) Compared With Peginterferon Alfa-2a (Alfa-2a) in HCV-Infected Patients (G1/2/3) With Compensated Cirrhosis: EMERGE Phase 2B Efficacy and Safety Results Through Week 12.

Lead Author: M Rodriguez-Torres, et al.

Clinical Development: Currently in Phase III.  PEG Lambda is injected once a week.

Results and Conclusion: This is an on-going study of 42 HCV genotype 1, 2, and 3 patients with compensated cirrhosis.  PEG Lambda was given at 120 ug to 240 ug weekly plus ribavirin (comparator arm PEG/RBV).  The safety results at week 12 found that Peg Lambda plus RBV achieved similar treatment and safety when compared to PEG/RBV, but there were lower rates of dose reductions and fewer blood deficiency type side effects.

Editorial Comments:  It will be interesting to keep an eye on PEG Lamdba.  Even though the future of HCV treatment is heading towards an interferon-free therapy, there will still be some people who may have to include interferon in the DAA combination to completely cure HCV.   (AF)

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Program #228: A Randomized, Placebo-Controlled Trial of Oral (Milk Thistle) for Chronic Hepatitis C: Final Results of the SYNCH Multicenter Study.

Lead Author:   Michael Fried, et al.

Results and Conclusion:  HCV patients (154 total) who had previously failed interferon treatment received either 420 mg or 700 mg silymarin, three times daily or placebo for 24 weeks. Silymarin was well-tolerated but there was no improvement in HCV-related biomarkers.

Editorial Comments: When it comes to HCV, silymarin is the most commonly used and tested dietary supplement, but its efficacy remains unproven. (LKP)

 

Treatment:  General

Program #487:  Changes in Oral Temperature after the Initial Injection of Peginterferon Alfa-2a in Patients with Chronic Hepatitis C Reflect Host-Interferon Responsiveness.

Lead Author: Hwalih Han, et al. Liver Diseases Branch, NIDDK, NIH.

Results and Conclusion: Treatment-naïve patients (60 total) participated in this study using peginterferon and ribavirin. Temperature increase was associated with response to treatment, as well as genetic factors, such as the presence of IL28B genotype.

Editorial Comments: Although fevers are an uncomfortable HCV treatment side effect, perhaps there is a bright side to this discomfort.  (LKP)

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Program # 986: Age above 60 Years Is Not a Negative Predictive Factor for Combined Antiviral Therapy with Pegylated Interferon Alpha and Ribavirin in Hepatitis C Patients.

Lead Author: Pascal Frei, et al.

Results and Conclusion: This retrospective analysis looked at data gathered from 545 Swiss patients who completed HCV antiviral therapy, 67 of whom were over age 60 years. Age did not correlate to probability of achieving an SVR. The researchers concluded that if the average 60 year-old lived to average life expectancy (additional 22 years), the improved survival rates that accompany SVR are worth considering.

Editorial Comments: These data likely apply to U.S. patients as the average life expectancy of 60 year-olds is an additional 22 years for men and 24 for women. (LKP)

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Program #1027: Actively Injecting Drug Users Can Be Successfully Treated with Antiviral Therapy for HCV, Are Unlikely to Be Re-Infected, and Significantly Reduce Their Illicit Drug Use.

Lead Author: Heather Lewis, et al.

Results and Conclusion: This study conducted in the U.K., treated 81 HCV patients, 48 of whom were active injection drug users. The SVR rates of the injection drug users were similar to those who were non-injection drug users. Reinfection rates were low and there was a significant reduction in injection drug use during and after HCV treatment.

Editorial Comments: The implications of this are far-reaching. The notion that HCV treatment is a practical treatment for HCV injection users has been shown in other research, but this adds a twist with the introduction of data showing the potential added benefit of reduction of injection drug use during and after HCV treatment. (LKP)

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Program #1055:  EPO Administration Suppresses Innate Immunity during Therapy-Induced Anemia in HCV Patients.

Lead Author: Michelle Spaan, et al.

Results and Conclusion:  The use of erythropoietin (EPO) to manage HCV treatment-induced anemia is debated, particularly because of EPO’s potentially serious side effects. This study shows that EPO may inhibit the immune system in chronic HCV patients.

Editorial Comments: Interferon stimulates the immune system, so potentially reducing it with EPO may be working at cross-purposes.  (LKP)

 

Epidemiology

Program# 243:  The Growing Burden of Mortality Associated with Viral Hepatitis in the United States, 1999-2007.

Lead Author:  Scott Holmberg, et al. Centers for Disease Control and Prevention’s Division of Viral Hepatitis.

Results and Conclusion:  Looking at data from 1999-2007, HBV-related deaths remained constant. Hepatitis C-related deaths increased to 15,106 in 2007 while HIV-related deaths decreased to 12, 734. The risk of death increased with comorbidity with chronic liver disease, coinfection with viral hepatitis or HIV, and effects of alcohol use.

Editorial Comments:  Holmberg recommended increased screening and access to care for HCV patients, without reducing services to HIV patients. The best time to act on this was decades ago, but since we didn’t, the next best time to act is now. (LKP)

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Program #394: Hepatitis C Virus Antibody Prevalence, Correlates and Predictors among Persons Born from 1945 through 1965, United States, 1999-2008.

Lead Author:  Bryce D. Smith, et al. Centers for Disease Control and Prevention’s Division of Viral Hepatitis.

Results and Conclusion:  More than 80% of those with anti-HCV (presence of HCV antibodies but not confirmed HCV viral load) were born from 1945 through 1965, with more than 85% reporting drinking an average of more than 2 drinks daily. Nearly a third of these are uninsured.

Editorial Comments:  Offering free or low-cost testing for everyone born from 1945 through 1965 would be a good place to start. Even if HCV patients did not have access to treatment, counseling and education for those who are diagnosed is a reasonable initial goal.  (LKP)

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Program #412:   Prevalence of HCV Viral and Host IL28B Genotypes in China.

Lead Author: L Wei, et al.

Results and Conclusion: China has an estimated prevalence of 25 million people infected with HCV.  This is the first survey of hepatitis C IL28B genotype conducted in China.  There were 1000 patients enrolled in the study from all areas of China.  It was reported that all HCV genotypes were found in China, but the majority of people in China infected with HCV are infected with genotype 1b.  In regards to IL28B gene variations, it was found that 84% of people infected with HCV in China have the CC genotype–the most favorable IL28B gene variation for being cured with current HCV treatment.

Editorial Comments:  The high prevalence of HCV in China is mind boggling.  I am looking forward to learning more about what China is offering its citizens in the way of healthcare and treatment of HCV especially when you consider that the majority of people in China infected with hepatitis C have the most favorable IL28B CC genotype.  When and if I can find the information I will pass it on to our readers.  (AF)

 

Disease Progression

Program #212 The Mediterranean Diet: Improvement in Hepatic Steatosis and Insulin Sensitivity in Individuals with NAFLD (Nonalcoholic liver disease).

Lead Author: Marno Ryan, et al.

Results and Conclusion:  This 6-week Australian study of 12 subjects with NAFLD demonstrated that liver fat could be reduced by as much as 39% even without weight loss in those who consumed a Mediterranean diet high in omega-3 fatty acids. When subjects consumed the National Heart Foundation Diet there was no significant improvement in NAFLD.

Editorial Comments: The health benefits of the Mediterranean diet have long been touted for heart and stroke prevention.  It makes sense that what is good for the heart is good for the liver.  (LKP)


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HEALTHWISE: Free from Hepatitis C
—Lucinda K. Porter, RN

This month’s Healthwise is short and smacks of shameless self-promotion. I am just so excited about the publication of my book, Free from Hepatitis C: Your Complete Guide to Healing Hepatitis C, that I am like a new grandmother showing off to anyone who will listen. However, unlike as with my grandchildren, a portion of the proceeds from my book is donated to increase hepatitis C awareness. (Grandchildren are also like non-profits, but without the tax benefits.)

Free from Hepatitis C translates my personal and professional experience into practical tips to help patients through treatment for chronic hepatitis C virus (HCV) infection. The participants in the HCV support group I co-facilitated provided a gold mine of tips for coping with treatment. Working as a clinical nurse, I walked through HCV antiviral therapy with many patients. I gathered more insight about how to manage side effects during my own two treatments.

I noticed that most of the patients I encountered did so well that I came to believe that getting through treatment was the result of knowing how, and not just luck. Seeing all this success, I decided to put what I learned into a book. I take no credit for this knowledge—it came from others—mostly patients and healthcare professionals. Their experiences helped me through my treatment and the book is my way of passing it on.

The book is fairly mainstream. I am not an expert on HIV/HCV coinfection or other co-morbid conditions. I hope my colleagues who are experts will take this on. For those wanting more information about HIV/HCV coinfection, I encourage you to check out organizations that specialize in this issue (these organizations also have excellent info on HCV as well as other health-related issues):

Another area that is minimally covered is harm reduction. Although I use a harm reduction model, I briefly touched on this subject. I believe that Diana Sylvestre, MD and Christopher Kennedy Lawford are much more qualified to address this area, and I recommend Healing Hepatitis C for those who want to read an honest book that addresses drugs and HCV.

I took the middle road for two reasons. First, I was told to write what I know, and I know the heavily travelled path well, having traversed it myself. Second, I wanted a book that focused on how to prepare for and manage HCV treatment. I held the hands of many patients and this book is a way to hold a few more. I think we can accomplish more if we aren’t alone, and HCV treatment is no exception. Perhaps a book is not a person, but it was the best way to let patients know that they are not alone.

I believe Free from Hepatitis C offers much for those who don’t want to undergo treatment. HCV treatment is not for everyone, so I address supplements and lifestyle choices for those who want to maximize their health. However, for those who want more information about liver disease, there are other good books out there. I particularly like Dr. Melissa Palmer’s Guide to Hepatitis and Liver Disease.

Naturally, I want everyone to read my book, as I believe it covers areas not covered by others that are out there. I am a huge fan of the public library and I know that some libraries have ordered it for their shelves. If you want more information about me, the book, and HCV visit my website lucindakporter.com or my slightly silly blog, hepatitiscomics.blogspot.com. I also have a presence on Facebook and Twitter.

Enough about me; the rest of this month’s HCV Advocate is devoted to coverage of the 2011 Liver Meeting of the American Association for the Study of Liver Diseases. There is still more work to be done, and it all begins with learning more.

Speaking of learning more, I picked up a few tips on how to manage anal itching that accompanies telaprevir. Look for that fact sheet at www.hcvadvocate.org.

As we head into the holiday season, remember this—hepatitis C is an inflammatory disease. Over time, chronic inflammation causes damage to our bodies, particularly the liver. The best way to reduce inflammation seems to be to maintain a healthy weight. If you are tempted by extra calories during the holidays, think about your liver, heart, brain, and overall health, and ask if the short-term joy is worth the long-term consequences. If it seems to be, then limit that joy to small amounts and increase your exercise.

Wishing you good health.

                          Lucinda

 

PS:

The book arrived just as my Healthwise article was going to press. I browsed through the book, and immediately found a glaring mistake. After the book left my hands, my well-meaning editor inserted the words peginterferon alfa-2a (Pegasys) where previously I had written the more general term, peginterferon. This would not have been so terrible had he also included the other important peginterferon, alfa-2b (PegIntron). Further, PegIntron was left out of the index, despite the fact that the PegIntron Redipen and Merck are both mentioned in the book. I take full responsibility for this, because I did proofread the entire book, and although my pre-print version did not include the index, this other error was there and escaped my notice.

I was sad to see this, not least of which it means patients don’t get all the information. Also, those companies who have helped so many to be free of hepatitis C certainly deserve acknowledgement. My publisher has assured me that this will be fixed before before the second printing, and we will address this directly with Merck.

Oscar Wilde said, "A poet can survive anything but a misprint." I am glad I am not a poet. Should you find any other errors, please let me know, so these may be corrected before the second printing. I have no control over the ads my publisher inserted at the end of the book. At best, I hope ads for my book end up at the back of someone else's.

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Book Review: Free from Hepatitis C
—Rose Christensen

Free from Hepatitis C: Your Complete Guide to Healing Hepatitis C, by Lucinda K. Porter, RN. Square One Publishers, 2011.

In the spirit of full disclosure, I have known and worked with Lucinda Porter for over 13 years. That being said, it would be a disservice to her and to the hepatitis C community for me to be anything but fair and objective in this review.

In Free from Hepatitis C, Lucinda has managed to provide an enormous amount of practical and useful information. I especially like her sometimes humorous approach to a serious subject.

Lucinda provides us with an overview of hepatitis C (HCV) that contains valuable, easy to understand information about HCV, how you contract it, and symptoms you may (or may not) have. This is especially helpful if you are newly diagnosed or don't have a lot of knowledge about HCV.

The most current treatments available are discussed in detail. More importantly, tools are provided to help you make the decision whether or not treatment is right for you. If you decide to undergo treatment, there are tips on how to prepare yourself physically, mentally, and emotionally along with what to expect.

The book is filled with tips on how to be as healthy as possible, whether or not you choose treatment. It touches on a wide variety of subjects including healthy eating, exercise, sleep, etc., and encourages a strong mind-body connection.

As a person who has been cured for 7 years, I wish this book had been available when I was considering and going through treatment. I would have benefitted greatly from the information on choosing a medical team and managing side effects, instead of just toughing it out.

An extremely valuable tool is the chapter "What to do When Treatment is Over." I feel that many of us who cleared the virus in the past were just "done" and there was very little information or support for what came after, regardless of whether or not we achieved an SVR.

Lucinda provides an extensive resource list and a glossary to help clarify some unfamiliar terms.

I would recommend that anyone with HCV or whose life is affected by it include this book in their library. You will find yourself referring to it often as you navigate through your journey with HCV.


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