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A Bi-Monthly Publication of the Hepatitis Support Project

October 10 , 2006
Volume 3, Issue 17

Liz Highleyman

To download pdf version click here

In This Issue:

Hepatitis C

• HCV Clearance in Siblings

• Causes of Death in People with Hepatitis B or C

• No Link between HCV and Heart Attacks

• Spleen Removal for Thrombocytopenia

• HCV Transmission Among Injection Drug Users

HCV Clearance in Siblings
One of the best ways to study the role of genetic factors in disease is to compare close relatives versus unrelated individuals. In the September 2006 issue of Gastroenterology, M. Fried and colleagues reported data from a study of spontaneous and treatment-related HCV clearance and liver disease progression in 257 HCV-infected siblings with hemophilia. They found that concordance (similarity) for spontaneous HCV clearance was two times higher in siblings compared with unrelated individuals (8.8% vs 4.3%). Concordance for response to interferon-based therapy was more than twice as high for siblings than unrelated people (31.3% vs 13.3%), but this difference was not statistically significant. The concordance for advanced liver disease was also higher among siblings than unrelated individuals (4.0% vs 2.3%), but this, too, did not reach statistical significance. The authors concluded that “[c]oncordance rates and heritability estimates for spontaneous and treatment-related viral clearance indicate that genetic factors have a modest influence on the outcome of hepatitis C, although shared environmental factors cannot be excluded.”

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Causes of Death in People with Hepatitis B or C
In the September 9, 2006 issue of The Lancet, J. Amin and colleagues reported on an analysis of data from a large community-based linkage study in Australia to investigate causes of mortality among patients with hepatitis B, C, or both. The study included 39,109 individuals with HBV; 75,834 with HCV; and 2604 HBV/HCV coinfected. There were 1233 deaths among the hepatitis B patients (3.2%), 4008 among the hepatitis C patients (5.3%), and 186 among HBV/HCV coinfected individuals (7.1%). People with HBV, HCV, or both had elevated rates of death due to liver-related causes and due to use of illicit drugs. Among the HCV patients, the elevated risk of death due to drug-related causes was significantly greater than that for liver disease. The greatest excess risk was seen in women aged 15-24. Hepatocellular carcinoma was the most common cause of liver-related death in people with chronic hepatitis B. “Our data highlight that young people with hepatitis C and with [HBV/HCV] coinfection face a higher mortality risk from continued drug use than from their infection,” the researchers wrote, “whereas the main cause of hepatitis B death was liver-related.”

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No Link between HCV and Heart Attacks
According to some recent research, HCV is associated with atherosclerosis, insulin resistance, and other risk factors for heart attacks. However, a case-control study by C. Arcari and colleagues, reported in the September 15, 2006 electronic edition of Clinical Infectious Diseases, found no link between HCV and elevated risk of acute myocardial infarction (MI). The study involved male active-duty U.S. army personnel aged 30-50. Case patients were individuals hospitalized for a first MI, while control subjects had no history of MI or hospitalization for cardiovascular disease. HCV test results were available for 292 case patients and 290 control subjects. Overall, 52 participants tested positive for HCV, for a prevalence of 8.9%; the rate was significantly higher among blacks (13.2%) compared with whites (6.8%) or other racial/ethnic groups (9.4%). The authors found no significant difference in the prevalence of HCV infection between patients who had heart attacks (7.6%) and control subjects (9.8%) after adjusting for age, race, education, and marital status. Not surprisingly, increased heart attack risk was significantly associated with smoking, high cholesterol, and work-related stress; however, high blood pressure and being overweight were not associated with a higher MI rate. The authors concluded that “[t]he results of this study do not indicate any relationship between HCV seropositivity and acute myocardial infarction and do not support previous reports in the literature of this association.” They noted, however, that active-duty military personnel are in overall good health and are younger than the age at which most heart attacks tend to occur.

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Spleen Removal for Thrombocytopenia
Some individuals with HCV-related cirrhosis have low MELD scores, meaning they do not have a high priority for liver transplantation. However, they may have advanced thrombocytopenia (low levels of platelets, cells necessary for blood clotting), which is a contraindication for interferon-based therapy. Patients with cirrhosis often have enlarged spleens that remove too many platelets from circulation, which can lead to excessive bleeding or bruising. In the September 2006 Journal of Clinical Gastroenterology, P. Hayashi and colleagues reported on a case series in which splenectomy (spleen removal) was performed to raise platelet counts. The researchers analyzed medical records from seven hepatitis C patients who underwent splenectomy for thrombocytopenia before starting treatment containing pegylated interferon (Peg-Intron). All seven patients experienced increased platelet counts by an average of 221 days after spleen removal (mean increase of 32,400 to 222,140 cells). There were no deaths or cases of portal vein thrombosis. Five patients completed therapy with pegylated interferon plus ribavirin (at the time of the report, one was still on therapy and one was awaiting treatment); among these, two achieved sustained virological response, one was a non-responder, one experienced HCV breakthrough during treatment, and one experienced HCV relapse after treatment. The authors concluded that “[s]plenectomy in patients with hepatitis C cirrhosis can be done safely to allow application of antiviral treatment and potentially avoid transplantation.”

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HCV Transmission Among Injection Drug Users
In the September 15, 2006 Journal of Infectious Diseases, D. Brewer and colleagues reported on a case-control study of HCV seroconversion among injection drug users (IDUs) in Washington State, looking at 17 case subjects with recent HCV infection and 42 HCV negative control subjects. Participants reported information about their drug injection and sex partners, and referred up to five partners for interviews and blood testing. The researchers found that 78% of recent drug injection partnerships involved behavior that could transmit HCV; nearly 25% involved syringe sharing. Newly infected IDUs had had more HCV-infected injection partners. Because HCV-infected and uninfected IDUs engaged in similar injection risk behavior, the authors said that “[s]eroconversion was mostly an accident of network position – that is, injecting with more individuals who happened to be HCV infected.” The network of people who injected drugs together was described as “connected, dense, and cyclic,” while the IDUs’ sexual network was “highly fragmented.” The authors suggested this sexual network would be “unable to serve as a scaffold for sustained transmission by itself,” in the absence of risky injection activity. The researchers concluded that “[w]ithout dramatic reductions in injection risk behaviors, shattering of cohesive injection networks, and/or broad coverage of an effective vaccine, HCV will likely remain hyperendemic in drug injectors.”

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