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A Bi-Monthly Publication of the Hepatitis Support Project

September 26 , 2006
Volume 3, Issue 16

Liz Highleyman

To download pdf version click here

In This Issue:

Hepatitis C

• Comparison of Pegasys vs Peg-Intron

• HCV Detection Using TMA Test

• Hispanics May Develop More Advanced Fibrosis

• Sexual Transmission of HCV

• HCV Risk Factors for Injection Drug Users

• HCV Transmission via Toothbrushes

Comparison of Pegasys vs Peg-Intron
In the August 2006 Journal of Hepatology, M. Silva and colleagues reported on a study comparing the pharmacokinetics and antiviral activity of 180 mcg/week pegylated interferon alfa-2a (Pegasys) vs 1.5mcg/kg/week pegylated interferon alfa-2b (Peg-Intron) in 36 patients with genotype 1 HCV infection. Patients were randomly assigned to receive Pegasys or Peg-Intron as monotherapy for four weeks, then added 13 mg/kg/day ribavirin for an additional four weeks. Although patients receiving Pegasys had higher blood drug levels, those receiving Peg-Intron had significantly greater up-regulation of interferon response genes, significantly greater maximum and average declines in HCV RNA, and were more likely to achieve at least a 2-log reduction in HCV viral load by week 8 (72% vs 44%). The researchers concluded that, “These findings suggest that the biological activity, measured by early interferon-induced gene transcripts and early antiviral responsiveness, may have been greater in patients treated with [Peg-Intron], despite their lower exposure to the drug compared with patients treated with [Pegasys].”

In an accompanying editorial, however, P. Jansen and H. Reesink cautioned against drawing premature conclusions about which form of pegylated interferon is better. After reviewing conflicting data from studies done to date, they wrote, “In terms of efficacy the books are still open.” Sustained virological response (SVR) is what really counts, they said, not early response. A larger study called IDEAL is due to report comparative SVR data for Pegasys vs Peg-Intron in the first half of 2007. “For the industry these trials are, economically speaking, life or death,” the authors concluded. “We should continue to make sense of the data and we should not decide too quickly that one drug is better than the other.”

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HCV Detection Using TMA Test
HCV viral load testing is routinely used to guide hepatitis C treatment. As reported in the August 2006 issue of Hepatology, C. Morishima and colleagues compared the more sensitive Bayer Versant HCV RNA Qualitative TMA assay (with a lower limit of detection of 9.6 IU/mL) and standard PCR viral load tests in the HALT-C trial, in which more than 1,000 prior nonresponders with advanced fibrosis were retreated with Pegasys plus ribavirin. Nearly all PCR-positive samples (99.9%) were also positive by the TMA assay. However, out of 1,294 PCR-negative samples, 22% were positive by TMA. Negative TMA results at 12 and 20 weeks predicted ultimate SVR better than negative PCR results, and none of the 45 patients who were TMA-positive but PCR-negative at weeks 20 and 24 went on to achieve SVR. “Negative TMA results at or after week 12 were superior to negative PCR results for predicting SVR,” the researchers concluded. “In patients with negative PCR results during treatment, a single positive TMA test did not exclude SVR, although persistently positive tests did.”

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Hispanics May Develop More Advanced Fibrosis
In the August 2006 American Journal of Gastroenterology, S. Verma and colleagues reported that Hispanic patients with chronic hepatitis C may be more likely to develop advanced fibrosis compared with non-Hispanic whites. They analyzed data from 169 Hispanic and 63 white patients at a Los Angeles clinic. On average, Hispanic patients were older and were more likely to have had a blood transfusion (40% vs 21%), to be obese (47% vs 21%), to have diabetes (16% vs 5%), and to have liver steatosis (79% vs 47%). Hispanic ethnicity and obesity were both independent predictors of steatosis. Compared with whites, Hispanics had a significantly higher average fibrosis stage, a higher grade of necroinflammation, and a faster rate of fibrosis progression. The researchers concluded that, “this study confirms that Hispanics have more advanced hepatic fibrosis than non-Hispanic whites.”

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Sexual Transmission of HCV
In the August 2006 issue of Sexually Transmitted Infections, J.M. Turner and colleagues provided further information about risk factors associated with an ongoing outbreak of apparently sexually transmitted hepatitis C among HIV positive gay/bisexual men in London. Between July 1999 and August 2000, participants completed a self-administered questionnaire about recent sexual activity and recreational drug use. Of the 308 men with adequate data, 11 were newly infected with HCV during follow-up. Factors associated with recent HCV infection were unprotected anal intercourse, more than 30 sexual partners in the past year, a higher number of new sex partners in the past month, use of sex toys, oral-anal sex, intranasal drug use, and especially anal fisting (P < 0.001). Men who practiced fisting were about six times more likely to be infected with HCV, but most also engaged in other high-risk sexual practices, making it difficult to determine which activities were responsible for transmission; in addition, five men who contracted HCV did not report fisting. Since hepatitis C treatment during acute infection is highly effective, the researchers recommended that, “consideration should be given to HCV RNA screening in individuals identified as being at high sexual risk.”

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HCV Risk Factors for Injection Drug Users
Two recent studies looked at risk factors for HCV infection among injection drug users (IDUs). As reported in the October 2006 issue of Addiction, L. Maher and colleagues recruited IDUs through street-based outreach, methadone and sexual health clinics, and needle exchange programs in New South Wales. A total of 368 HCV negative IDUs were enrolled and followed every 3-6 months, completing questionnaires about demographics, drug use, and risk behavior. During the follow-up period, there were 68 HCV seroconversions (30.8 per 100 person-years). Among participants who had been injecting drugs for less than one year, the incidence rate was more than four times higher, at 133 per 100 person-years. Independent predictors of HCV seroconversion were female gender, shorter duration of injection, cocaine injection, shared use of cotton or other filters, and recruitment through street outreach.

In the second study, reported in the August 2006 Journal of Viral Hepatitis, C. Mathei and colleagues estimated the risk of sharing drug injection equipment. They found that “sharing of materials other than syringes/needles indeed seemed to contribute substantially to the spread of hepatitis C among injecting drug users.” Together, these studies suggest that prevention programs targeting IDUs should educate users about the risk of sharing equipment such as filters, cookers, spoons, and rinse water, as well as needles and syringes.

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HCV Transmission via Toothbrushes
HCV prevention guidelines often advise against sharing toothbrushes, razors, and other personal care items that may come into contact with blood. G. Lock and colleagues examined whether toothbrushes of HCV positive individuals are likely to harbor the virus; results were published in the September 2006 Journal of Viral Hepatitis. Saliva specimen from 30 subjects collected before and after tooth brushing, plus toothbrush rinse water, were tested for HCV RNA. Saliva collected before tooth brushing was positive for HCV RNA in 9 patients (30%), while 11 saliva specimens collected after brushing had detectable HCV (36.7%); 12 toothbrush rinse water specimens (40%) also tested positive for HCV. The researchers concluded that, “Our study demonstrates a contamination with HCV RNA of a considerable portion of toothbrushes used by hepatitis C patients, suggesting at least a theoretical risk of infection by sharing these objects.”

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