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Week Ending: August 19th , 2006
Alan Franciscus
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August 12, 2006
Hepatitis C-Related Liver Cancer Mortality on the Rise: Report
http://www.cna.com.tw/
By Sofia Wu
Taipei, Aug. 11 (CNA) Mortality of hepatitis C-related liver cancer has been rising in Taiwan, particularly in the southern counties of Yunlin, Chiayi and Tainan, according to a study report released Saturday.
The report, prepared by eight medical centers around the country, analyzed more than 18,000 liver cancer cases recorded between 1981 and 2001, which found an upward trend in over liver cancer mortality.
As deaths from hepatitis B-related liver cancer didn't increase during the period, the report said the surge could largely be attributed to rising mortality from hepatitis C-related liver cancer.
The report also found that the Yunlin-Chiayi-Tainan area was hardest hit by hepatitis C as the region's liver cancer mortality was higher than the national average.
According to the report, about 40 percent to 50 percent of male liver cancer deaths in the region were hepatitis C patients, while the ratio among women in the three counties ranged between 60 percent and 80 percent.
Chen Chien-hung, a doctor at National Taiwan University Hospital's department of internal medicine, said the high hepatitis C mortality in the Yunlin-Chiayi-Tainan region might be related to inappropriate medical treatment administered by unlicensed doctors there some 20 years. But he added that it's just speculation that requires epidemiological surveys to verify.
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August 13th, 2006
Panel Backs Expansion of Drug Tests in Prisons
http://www.iht.com
By Ian Urbina, The New York Times
PHILADELPHIA An influential panel of medical advisers has recommended that the U.S. government loosen regulations that severely limit the testing of pharmaceuticals on inmates, a practice that was all but stopped three decades ago after disclosures of abuse.
The proposed change includes provisions intended to prevent problems that plagued earlier programs. Nevertheless, it has dredged up a painful history of medical maltreatment and sparked debate among prison rights advocates and researchers about whether prisoners can make uncoerced decisions.
Supporters of such programs cite the possibility of benefit to prison populations and the potential for contributing to the greater good.
Until the early 1970s, about 90 percent of all pharmaceutical products were tested on inmates, federal officials say. But such research diminished sharply in 1974 after disclosures of abuse at places like Holmesburg Prison here, where inmates were paid hundreds of dollars a month to test items as varied as dandruff treatments and dioxin, and where they were exposed to radioactive, hallucinogenic and carcinogenic chemicals.
The regulations were also partly a reaction to the disclosure in 1972 of the Tuskegee Study of Untreated Syphilis in the Negro Male, which was begun in the 1930s and lasted 40 years. In it, several hundred men with syphilis in rural Alabama, most of them illiterate, were left untreated, even after a cure was discovered, so that researchers could study the disease.
"What happened at Holmesburg was just as gruesome as Tuskegee, but at Holmesburg it happened smack dab in the middle of a major city, not in some backwoods in Alabama," said Allen Hornblum, an urban studies professor at Temple University here who wrote "Acres of Skin" in 1998, a book detailing the Holmesburg research. "It just goes to show how prisons are truly distinct institutions where the walls don't just serve to keep inmates in, they also serve to keep public eyes out."
Critics doubt the merits of pharmaceutical testing on prisoners who may lack basic health care.
"It strikes me as pretty ridiculous to start talking about prisoners' getting access to cutting-edge research and medications when they can't even get penicillin and high-blood-pressure pills," said Paul Wright, editor of Prison Legal News, an independent monthly review. "I have to imagine there are larger financial motivations here."
Alvin Bronstein, a Washington lawyer who helped found the National Prison Project, an American Civil Liberties Union program, said he did not believe that altering the regulations risked a return to the days of Holmesburg.
"With the help of external review boards that would include a prisoner advocate," Bronstein said, "I do believe that the potential benefits of biomedical research outweigh the potential risks."
For Leodus Jones, a former prisoner, the report has opened old wounds. "This moves us back in a very bad direction," said Jones, who participated in the experiments at Holmesburg in 1966 and, after his release, played a pivotal role in lobbying to get the regulations passed.
In one experiment, Jones's skin changed color, and he developed rashes on his back and legs where he said lotions had been tested.
"The doctors told me at the time that something was seriously wrong," said Jones, who said he had never signed a consent form. He reached a $40,000 settlement in 1986 with the City of Philadelphia after he sued over the experiments.
Dr. Bernard Ackerman, a New York dermatologist who worked at Holmesburg as a second-year resident from the University of Pennsylvania in the 1960s, said he remained skeptical.
"I saw it firsthand," Ackerman said. "What started as scientific research became pure business, and no amount of regulations can prevent that from happening again."
The pharmaceutical industry says it was not involved. Jeff Trewitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, said that his organization had no role in prompting the study and that it had not had a chance to review the findings.
Professor Ernest Prentice of the University of Nebraska, chairman of the federal committee, said the sole focus was to see if prisoners could benefit by changing the regulations.
"The current regulations are entirely outdated and restrictive, and prisoners are being arbitrarily excluded from research that can help them," Prentice said. The regulation revision process will begin at the committee's next meeting, on Nov. 2, he said.
The U.S. prison population has more than quadrupled, to about 2.3 million, over the past 30 years and disproportionately suffers from HIV and hepatitis C, diseases that some researchers say could be better controlled if new research were permitted in prisons.
The demand for human test subjects has grown so much that an industry has emerged in the past decade to recruit volunteers for pharmaceutical trials. The Tufts Center for the Study of Drug Development in Boston estimated that the industry's revenue grew to $7 billion in 2005, up from $1 billion in 1995.
In the past two years, several pain medications, including Vioxx and Bextra, have been pulled off the market. Early testing of those drugs did not include large enough numbers of patients to catch dangerous problems.
Barclay Walsh contributed research.
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August 14th, 2006
Fate Uncertain for Canada's Legal Drug-Shooting Site
http://www.reutershealth.com/
By Allan Dowd
VANCOUVER, British Columbia (Reuters) - Supporters of North America's only sanctioned injection site for drug addicts say the facility is saving lives and curbing disease but they fear that will not be enough to keep Canada's government from closing it.
Vancouver's Insite facility gained international publicity when it opened in 2003 as a research experiment and health officials are anxiously waiting to hear if the Canadian government will extend its exemption from drug laws and allow it to remain open after September 12.
Insite's supporters say studies show the facility has prevented overdose deaths and helped get addicts into treatment. They say it also has slowed the sharing of needles, which is how AIDS and other diseases are often spread.
But the supporters worry the facility's future may depend on political ideology. Insite was opened under a previous Liberal government in Ottawa and new Conservative Prime Minister Stephen Harper has objected to any government sanction of illegal drug use.
"We're trying to make sure he (Harper) doesn't drive the car over the edge of the cliff before he checks the science," said Mark Townsend of the Portland Hotel Society, a non-profit group that helps run Insite.
According to the Vancouver Coastal Health Authority, which also oversees Insite, the facility in the drug-infested Downtown Eastside neighborhood receives an average of 607 visits a day and has been used by more than 7,200 people.
Addicts using drugs such as heroin and cocaine are given clean needles to inject themselves in a room supervised by a nurse. After shooting up, they go to a "chill-out room" before returning to the streets.
GOAL IS TO SAVE LIVES
The facility's supporters say the goal is saving addicts' lives by giving them access to medical help in overdose cases and resources to help them kick their addictions.
There have been more than 500 overdoses at the site but none has been fatal, which would have been the likely outcome if the addict had been alone on the street, health officials say.
To open the facility, local officials got a three-year exemption from federal drug possession laws as they studied Insite's impact on overdose deaths and other drug-related problems in the surrounding community. The exemption must be renewed for Insite to remain open.
Federal health officials are reviewing the results of the Insite studies, said Erik Waddell, a spokesman for federal Health Minister Tony Clement, who opposed injection sites while a provincial official in Ontario.
Harper said in May he would not decide the site's future until getting a report from the Royal Canadian Mounted Police, which strongly opposed Insite's opening in 2003.
A report prepared for the RCMP this year and obtained by Reuters said the site's impact on the community was difficult to assess but it appeared to have met its objectives in reducing overdose deaths.
Vancouver police have asked the federal government to keep the facility open.
The federal government has provided about C$500,000 per year to fund the research while the province paid C$1.2 million to build the site and provided operational funds through the regional health authority.
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More Advanced Hepatic Fibrosis in Hispanics with Hep C
www.gastrohep.com
Hispanics have more advanced hepatic fibrosis than non-Hispanic whites, and is related to a greater prevalence of diabetes mellitus, finds August's American Journal of Gastroenterology.
Dr Sumita Verma and colleagues from Los Angeles assessed whether Hispanics have more advanced Hepatitis C virus-related liver disease than non-Hispanic whites.
The investigative team identified contributory factors.
Liver fibrosis and necroinflammation were assessed by the Ishak scoring system.
The team graded hepatic steatosis as 0 to 4.
The investigative team evaluated a total of 232 patients.
Of these, 63 non-Hispanic whites and 169 Hispanic.
Hispanics were older and had a higher prevalence of blood transfusion, obesity, diabetes mellitus, and hepatic steatosis.
The investigators found that Hispanic ethnicity and obesity were independent risk factors for hepatic steatosis.
Age at biopsy was an independent predictor of fibrosis -- American Journal of Gastroenterology
Compared with non-Hispanic whites, Hispanics also had higher fibrosis stage, necroinflammation grade, and faster fibrosis progression per year.
The team noted that the presence of diabetes mellitus, and grade 1 to 2 hepatic steatosis were independent predictors of fibrosis stage 4.
Alanine aminotransferase and aspartate aminotransferase levels more than 1, and necroinflammation grade were independent predictors of fibrosis.
Age at biopsy, and serum bilirubin were independent predictors of fibrosis stage 4.
Dr Verma's team concluded, “This study confirms that Hispanics have more advanced hepatic fibrosis than non-Hispanic whites.”
“This is related to older age, higher necroinflammation grade, and greater prevalence of hepatic steatosis and diabetes mellitus.”
Am J Gastroenterol 2006:101(8):1817
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Hep C Genotype 1 Predominates in the USA
www.gastrohep.com
Persons with Hep C are predominantly infected with genotype 1, including a disproportionate number of non-Hispanic blacks, shows this month's Gastroenterology.
The long-term benefits of antiviral therapies for chronic Hepatitis C are influenced by the frequency of characteristics that affect response in the population treated.
Dr Omana Nainan and colleagues determined Hepatitis C genotypes and RNA titers among Hepatitis C-infected persons in the general population of the United States.
The team determined genotypes from the NS5b region.
The researchers assessed 275 Hepatitis C RNA-positive participants in the Third National Health and Nutrition Examination Survey conducted during 1988 to 1994.
The research team identified that the Hepatitis C genotypes included 1a, 1b, 2a, 2b, 3a, 4, and 6.
Genotype 1 occurred in 91% of non-Hispanic blacks -- Gastroenterology
Based on weighted analysis of persons infected with genotypes 1, 2, and 3, genotype 1 predominated in all age groups.
By racial/ethnic group, the team found genotype 1 in 91% of non-Hispanic blacks, 70% of non-Hispanic whites, and 71% of Mexican Americans.
After adjusting for age and gender, only non-Hispanic black race/ethnicity was independently associated with genotype 1 infection.
The researchers observed that the overall geometric mean concentration of Hepatitis C RNA was 2.1 × 106 IU/mL.
Concentrations above 2 million IU/mL were found in 53% overall, and 50% of persons with genotype 1.
Dr Nainan's team commented, “Persons with chronic Hepatitis C in the United States who may require treatment in the foreseeable future are predominantly infected with genotype 1, including a disproportionate number of non-Hispanic blacks.”
“These features emphasize the need for improved therapies that reduce or eliminate complications from genotype 1 infections.”
Gastroenterol 2006: 131(2): 478-84
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Hepatitis Vaccine Plea after Needle Stick Terror
http://www.eveningtimes.co.uk/
MICHAEL HUGHES faces an agonising wait until October for test results after he was jagged by a needle found in a bin.
A COUNCIL worker is calling for binmen and street cleaners to be vaccinated against deadly Hepatitis B after he was jabbed by a needle at work.
Michael Hughes, from Partick, now faces an agonising wait to be told whether he has caught the liver condition Hep B or two other potentially fatal diseases, HIV and Hepatitis C.
Street cleaner Michael, 50, was emptying a litter bin on Dumbarton Road when he was jagged by the needle which he found mixed in with other drug paraphernalia such as bent spoons and empty paper wraps.
Since then the Glasgow City Council cleansing department worker's life has been on hold as he struggles to come to terms with the incident.
Michael, who has been off work due to stress since the accident, said: "I've been a nervous wreck since this happened.
"I've been prescribed sleeping tablets and my relationship with my girlfriend is suffering as I am on edge all the time. I just can't stop thinking it was a junkie's dirty needle that stabbed me.
"I don't get the test results until the middle of October - until then my future is on hold."
He continued: "The council should vaccinate all binmen and street cleaners as a matter of urgency - I don't understand why we weren't already. We are risking our lives every day and should be protected."
After being jagged by the needle Michael underwent a programme of immunisation injections which he claims he had to organise and pay for himself because the council did not act quickly enough.
At present nurses, doctors and the police are vaccinated against Hepatitis B, a condition which can lead to serious liver problems, and in the worst cases, death.
A Glasgow City Council spokeswoman said: "The council carries out risk assessments on the duties of staff in areas where contact with needles is possible.
"However, with the advent of wheeled bins and the needle uplift service we provide, accidents involving 'sharps' are fairly rare so mass inoculation is not required."
She added: "We cannot comment on individual cases but when such unfortunate incidents do happen we provide full medical support."
Jim Moohan, senior organiser for the GMB Union, said: "This must be taken seriously by Glasgow City Council."
TIMESFILE:
- Hepatitis is a condition that causes inflammation of the liver. There are three strains of the disease:
- Hep A: A viral, usually acute infection that is rarely serious. Usually caught by putting something contaminated with the virus into the mouth. It does occur in the UK, but more common in Africa, Asia and Central America where sanitation is poor.
- Hep B: Virus caused by the spread of blood or bodily fluids. Drug users who share needles are at a high risk of infection. Most people are able to fight off the infection, but some go on to develop chronic Hep B, which can be very serious and lead to liver failure or cancer of the liver.
- Hep C: a blood-borne viral infection, particularly risky to injecting drug users. Some people with the infection never develop symptoms, some go on to develop mild to moderate liver damage, while 20% get serious liver damage, which can lead to death. However, treatment clears the infection in half of cases.
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New Hope for Hepatitis C Research
http://www.medicalnewstoday.com/
The mystery surrounding Hepatitis C, a disease that affects millions of people worldwide, is one step closer to being solved.
In a paper published in the August edition of Journal of Virology, scientists describe how they replicated, or reproduced the hepatitis C virus (HCV) in mouse cells. Working with different models, they showed a gene called protein kinase R (PKR) blocked the replication of HCV in mice.
"When a person becomes infected with HCV, the immune system produces a protein called interferon to fight the infection," said co-author and Director of the Monash Institute of Medical Research, Professor Bryan Williams.
"We now know genes interferon stimulates PKR to try to stop the virus spreading throughout the body."
HCV replicates at a very high rate - approximately one trillion viral particles are produced each day in an infected person. Professor Williams' research will provide a better understanding of how this replication occurs and how and why PKR blocks the production of the virus.
Hepatitis C affects 210,000 Australians. Worldwide, it is estimated more than 170 million people suffer from the disease. The virus attacks the liver, causing flu-like symptoms, fevers, abdominal pain, depression, and for two-thirds of patients, chronic liver disease.1
The discovery may also shed light on why some hepatitis C patients respond better to treatment than others.
"As there is no vaccine or cure for HCV, the only treatment on offer for patients is interferon therapy, which aims to slow the progression of the disease. However, there are six different genotypes, or strains of HCV, which all react differently to treatment," Professor Williams said.
"We can now explore why some strains are more sensitive to interferon therapy, and how we can adapt treatment to the different strains of the disease."
"Our research is still in the early stages, but the research model we have created will be a valuable tool in understanding the underlying mechanisms of chronic HCV infection, and how the virus responds to interferon treatment" said Professor Williams.
###
Research collaborators were the Monash Institute of Medical Research, the Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, Kentucky, USA and the Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, USA.
A full copy of the research paper is available at: http://jvi.asm.org/current.dtl
#VIRUS_CELL_INTERACTIONS
1. Hepatitis C Council of Victoria: http://www.hepcvic.org.au/
More information:
Contact Julie Jacobs
Public Relations Manager
(+61 3) 9594 7109
Research Australia
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MedMira Offers New Rapid Diagnostic to Combat "the hidden epidemic" - Co-infection with HIV/Hepatitis C
http://biz.yahoo.com
Multiplo Delivers Simultaneous Rapid Diagnosis of HIV and Hepatitis C - XVI International AIDS Conference
TORONTO, Aug. 14 /CNW/ - An estimated 56,000 Canadians are living with HIV infection (The Public Health Agency of Canada) - and 30% of them don't know it. Another estimated 251,000 Canadians are infected with hepatitis C and, because of the lack of symptoms, 95,000 of them don't know it. (Public Health Agency of Canada)
Up to 33% of those infected with HIV/AIDS are also infected with Hepatitis C (www.hivandhepatitis.com) - prompting some researchers to describe HIV/Hepatitis C co-infection as "the hidden epidemic."
The issue of co-infection is one of growing concern for delegates at Toronto's XVI International AIDS Conference this week. MedMira, a leading Canadian manufacturer of reliable, fast, and easy-to-use diagnostics, is launching a tool to make the important diagnosis of HIV/Hepatitis C co-infection much simpler.
Multiplo(TM) Rapid HIV/HCV Antibody Test (Multiplo HIV/HCV) is the first rapid test to simultaneously identify both HIV and Hepatitis C (HCV) infections.
Co-infected individuals have a more rapid progression of HCV liver disease. In addition, some studies suggest that infection with certain HCV genotypes may accelerate the progression of HIV. HCV may also result in patients discontinuing HIV antiretroviral treatment due to liver toxicity.
"More health agencies and researchers are recognizing the benefits of testing for both HIV and Hepatitis C in the same three-minute procedure. Multiplo HIV/HCV lets you know more and know quickly, so that you can make the right treatment decisions, right away," says Hermes Chan, President & CEO, MedMira.
Multiplo HIV/HCV is a product that enables healthcare providers and other users to obtain two test results in three minutes or less in comparison to other tests that may take 10 to 40 minutes to obtain just a single result.
Chan continued, "Multiplo HIV/HCV is the first of a series of combination tests that MedMira will launch under the Multiplo line. Multiplo means that with a single specimen, patients and healthcare providers can receive multiple, instant results, without timers, or specialized equipment. One test, more answers."
MedMira will be showcasing the Multiplo HIV/HCV at the XVI International AIDS Conference in Toronto, from August 13-18th.
About MedMira
MedMira is the leading global manufacturer and marketer of in vitro flow-through rapid diagnostic tests. MedMira's tests provide reliable, rapid diagnosis in just 3 minutes for the detection of human antibodies in human serum, plasma or whole blood for diseases such as HIV and hepatitis C. The United States FDA, the SFDA in the People's Republic of China and European Union have approved MedMira's Reveal(R) G2, MiraWell(R) and MiraCare(TM) rapid HIV tests, respectively. The MedMira Rapid HIV Test has been approved by Health Canada.
MedMira's Reveal(R) G2 and MiraWell(R) rapid HIV tests are currently used in clinical laboratories, hospitals, and clinics where professional counselling and patient treatment are immediately available.
MiraCare(TM) is sold through MedMira's distributor network to pharmacies, hospitals and laboratories in the European Union. It is also available over-the-counter (OTC) in pharmacies throughout Hong Kong and Macao Special Administrative Regions, in the People's Republic of China.
Multiplo HIV/HCV is the first in MedMira's line of rapid tests for multiple diagnoses of infectious diseases. Multiplo HIV/HCV simultaneously detects HIV and HCV antibodies in a single specimen in less than 3 minutes.
MedMira delivers rapid diagnostic solutions to healthcare communities around the globe. Its corporate offices and manufacturing facilities are located in Halifax, Nova Scotia, Canada with a representative office and joint venture manufacturing facility in Guilin, China.
This news release contains forward-looking statements, which involve risk and uncertainties and reflect the company's current expectation regarding future events. Actual events could materially differ from those projected herein and depend on a number of factors including, but not limited to, changing market conditions, successful and timely completion of clinical studies, uncertainties related to the regulatory approval process, establishment of corporate alliances and other risks detailed from time to time in the company quarterly filings.
The TSX Venture Exchange has not reviewed and does not accept responsibility for the adequacy or accuracy of this statement.
For more information visit MedMira's website at www.medmira.com.
For further information
Source: MEDMIRA INC.
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Wyeth, ViroPharma Research Hits Milestone Stage
http://biz.yahoo.com
ViroPharma Inc. and Wyeth Pharmaceuticals said Monday that the experimental hepatitis C drug they are jointly developing achieved a "proof of concept" milestone under the companies' research agreement.
The milestone -- which means research results are positive enough to move forward with further testing -- triggers a requirement that Wyeth purchase $10 million worth of ViroPharma (NASDAQ: VPHM - News) stock.
The review of data is ongoing, but the companies expect preliminary data on their HCV-796 drug from a phase-I study -- which tested safety in healthy volunteers -- will be available by the end of August.
Phase-II studies, which measure safety and effectiveness, are expected to begin during the fourth quarter.
ViroPharma of Exton, Pa., and Wyeth Pharmaceuticals of Collegeville, Pa., have been partners in hepatitis C antiviral development since 1999.
Wyeth Pharmaceuticals is a division Wyeth (NYSE:WYE - News) of Madison, N.J.
Published August 14, 2006 by the Philadelphia Business Journal
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Canada's Homegrown Epidemic
http://www.canada.com
Andrew Duffy, The Ottawa Citizen
Health officials worry an HIV/AIDS epidemic is about to 'explode' among natives, writes Andrew Duffy.
Canadian health researchers are warning that the steady advance of HIV within Canada's native community shares some disturbing hallmarks with the epidemic in Africa.
Statistics published by the Public Health Agency of Canada earlier this month show that natives accounted for nine per cent of new HIV cases in the country last year, even though aboriginals comprise just 3.3 per cent of the overall population.
The infection rate among natives is now three times that in the general population.
"What we have seen over a period of time is that the numbers are just not going down. We continue to be over-represented in the new infections," said Kevin Barlow, executive director of the Ottawa-based Canadian Aboriginal AIDS Network.
The epidemic within the aboriginal community has some unusual and disturbing features.
The virus is much more likely to be transmitted by intravenous drug use in the native community. Women now account for nearly half (45.1 per cent) of all reported HIV cases among natives, while women in the general population make up about one-fifth of reported cases. In all, an estimated 2,300 to 4,500 Canadians were infected with HIV in 2005.
Natives under of the age of 30 also face an elevated risk of contracting HIV as compared to other young Canadians.
What's more, there are troubling signs that the already high rate of HIV infection among the country's one million natives could soon explode.
A recent study by the B.C. Centre for Excellence in HIV/AIDS found that the hepatitis C infection rate -- a common harbinger for HIV -- has skyrocketed among aboriginal intravenous drug users in Vancouver and Prince George.
Patricia Spittal, principal investigator of the Cedar Project study, said HIV/AIDS has the potential to devastate native communities in much the same way that it has ravaged villages in sub-Saharan Africa.
"We have to be worried about the similarities between here and Africa," said Ms. Spittal, an anthropologist who lived for two years at a Ugandan truck stop as part of her HIV/AIDS research in Africa. "The circumstances are the same: When you have human rights violations, and a combination of poverty and despair, you have to be worried."
The Cedar study found that 57.1 per cent of Vancouver's aboriginal injection-drug users had hepatitis C. The situation was even worse in Prince George, a small city of 77,000 in northern B.C. where 62.4 per cent of aboriginal IV drug users tested positive for the disease.
Hepatitis C spreads more rapidly and efficiently than HIV, but both viruses are commonly passed through the sharing of infected needles.
"It's like a warning bell," said Dr. Martin Schechter, chairman of the department of health care and epidemiology at the University of British Columbia. "It's telling us that all the ingredients are there for HIV to catch up to hepatitis C and go even higher."
Preliminary findings of the study were reported last year because members of a native advisory board were so alarmed by its numbers. Researchers found that among aboriginal injection drug users, the HIV infection rate in Prince George was lower (7.9 per cent) than in Vancouver (17 per cent), but experts believe that gap could close rapidly given the elevated rates of hepatitis C.
"The worry is that we're already seeing in the Cedar study prevalence rates in young aboriginal drug users that are worryingly high," said Dr. Schechter. "One potential disaster scenario is that you get the rapid spread of HIV."
Such "explosive outbreaks," he said, have taken place in neighbourhoods in Edinburgh, Bangkok, Vienna and Baltimore, where people gather to share intravenous drugs. Vancouver's downtown East Side experienced a similar explosion in 1996-97, when the prevalence of HIV among drug users climbed rapidly to 30 or 40 per cent.
It has been estimated that Vancouver's downtown East Side, the city's poorest neighbourhood, is home to 4,700 intravenous drug users, about 25 per cent of whom are aboriginal. A 2003 study found that the aboriginal drug users were becoming HIV-positive at twice the rate of others.
"When people tell me they want to work in the developing world, I say, 'OK, let's work on the downtown East Side of Vancouver because those prevalence rates are what you see in sub-Saharan Africa," Dr. Schechter said.
The Cedar study suggests the threat posed by the combination of IV drug use and HIV extends beyond Vancouver's East Side to places such as Prince George.
Researchers found that injection drug users in Prince George tended to shoot cocaine, morphine or dilaudid more often than heroin -- the injection drug of choice on the East Side. Since the effects of other opiates don't last as long as heroin, drug users in Prince George injected themselves more frequently than those in Vancouver, the study found. That behaviour put them at greater risk, since each shared needle increases the chances of contracting HIV.
Ms. Spittal wants to expand the Cedar study to confirm what many native leaders are telling her -- that the situation in Prince George reflects what they see happening in Kamloops, Kelowna and Prince Rupert.
Other studies have shown that natives are over-represented among IV drug populations in cities across the country. A 2004 study by Health Canada that recruited 794 IV drug users in Toronto, Sudbury, Regina and Victoria reported that 40 per cent of them were aboriginals.
"I think that many native service providers are very worried," Ms. Spittal said.
Chief Wayne Christian of the Splats'in First Nation, near Kelowna, said his community, which was once plagued by alcoholism, is now beset with drug issues. Crystal meth and crack cocaine are common.
"I'm really concerned that if it transitions into intravenous drug use, then we're going to have a real problem on our hands," Mr. Christian said.
The Splats'in First Nation, a community of 750 people, has suffered one fatal drug overdose and another suspected one during the past three months.
Mr. Christian believes drug addiction has flowered in his community because of the poverty, despair and dysfunction that resulted from what he called "genocidal" government policy.
In B.C., he said, adult natives have been scarred by experiences with residential schools and foster care, leaving them ill-equipped to be parents themselves. The resulting family breakdown and pain, he said, have led many young people to escape into the drug underworld.
Ms. Spittal considers the HIV infection rate among B.C.'s natives to be a human rights and child protection issue.
"When you see high levels of pain, despair, poverty, and the impact of colonization, I can't rant enough about that," she said. "It's really important to locate this discussion there -- in the erosion of culture and identity that are directly related to residential schools."
Native leaders fear drug use is on the rise at First Nations communities across the country.
Crystal meth has invaded many native reserves, said the Canadian Aboriginal AIDS Network's Mr. Barlow, because it's relatively easy to manufacture on site. Crystal meth often acts as a springboard to IV drug use, he said, drawing natives into city neighbourhoods known for their drug cultures.
"I would say B.C. is very similar to what is happening in most of the western provinces," he said. "If you go to downtown Winnipeg, Edmonton, Calgary or Regina, you will see very similar situations."
Intravenous drug use is at the heart of the native epidemic. More than half (53 per cent) of all new HIV infections among natives are attributable to infected needles. In the general population, only 14 per cent of new infections were attributed to IV drug use last year.
The use of injected drugs is central to the elevated risk of contracting HIV faced by aboriginal women and youth.
"It's such a volatile area of concern," Mr. Barlow said. "Let's say if one person is positive and they're sharing needles with three or four individuals. Then the numbers jump that quickly. If those people then share needles, the numbers can grow exponentially. That's the challenge."
The sex trade and the prison system, both of which contain significant native populations, also act as dangerous vectors for HIV infection.
Mr. Barlow said more research needs to be done to better understand the epidemic within the native community and the perceptions, practices and barriers to effective prevention. With a budget of $1.2 million, the Aboriginal AIDS Network delivers research, training and prevention programs across the country.
"When we look at the populations that are at-risk groups within the aboriginal population -- sex trade workers, injection drug users, inmates, youth, two-spirit (gay) men -- we have to find different ways of creating awareness in our communities," Mr. Barlow said.
"We have these multiple layers that make it really hard to engage people and get them receiving services, and changing risk behaviours."
Mr. Christian, who has worked as a drug and alcohol counsellor for 14 years, said he fears many aboriginal drug addicts are going to cities because First Nations don't have the expertise to deal with their problems on reserves.
He wants the federal government to spend more money on programs that offer drug addicts clean needles and safe, temporary housing. Housing is a critical measure, he said, because it offers drug users an alternative to living on city streets, where they often first engage in IV drug use and high-risk sexual behaviour.
"People have to understand that harm reduction is part of the continuum of healing," said Chief Christian.
"We have to do things now if we really believe that our children are our future. We have to take action, not tomorrow, right now, and put things in place."
In Prince George, a city task force has developed a strategy to address the IV drug problem. Hours at the needle exchange program have been extended and a van has been purchased to bring clean needles to addicts on the street.
But Mary Teegee, manager of community health and development for Carrier Sekani Family Services in Prince George, said new money for the HIV epidemic is scarce.
"It's very frustrating," Ms. Teegee said. "There's no big influx of resources coming to the North like there was in Vancouver in the early 1990s, even though we have the same or higher HIV rates. Is it systemic racism? I don't know, but there has to be something done."
Three of her young cousins in northern B.C. are now HIV-positive. One fell into a downward spiral after he was dumped without support from foster care.
"He said, 'My family became the people on the streets of Prince George'," Ms. Teegee said. "He ended up getting addicted to drugs; he ended up in jail and contracted HIV."
The federal government will spend $55.2 million this year on its national HIV/AIDS strategy. Funding for the federal initiative is scheduled to rise to $84.4 million in 2008, when $5.9 million will be earmarked for aboriginal programming.
Ontario Regional Chief Angus Toulouse, chair of the Assembly of First Nations' health and social development committee, said the federal government agreed to a $1.3-billion investment in native health under the Kelowna Accord. But that deal has not been honoured by the Conservative government of Prime Minister Stephen Harper.
"It's just a matter of time before whole aboriginal communities are wiped out because of the HIV/AIDS epidemic," Mr. Toulouse warned. "It's essential that the children and youth are instructed about the disease and about the behaviours that will really put them at risk. That's the kind of action plan and activity we need."
Ms. Spittal believes concerted action must be taken, given that 60 per cent of Canada's native population is under the age of 30 and increasingly at risk.
"Our message is: hit hard, hit fast. We do have an opportunity to make a difference," she said. "But if we continue to ignore it, we are going to see so many more infections."
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August 15th, 2006
Rwanda: Beauty and the Beast
http://allafrica.com/
The New Times (Kigali)
DR Mohamed Mohmood
Kigali
It is important to touch on HIV every now and again to serve as a reminder that it is real. Everybody should take personal responsibility for their actions and watch out for each other. Most importantly every one should get tested. Make up artists, manicurists, beauty therapists and hairdressers should pay close attention to this piece.
In 1965, a Medical researcher managed to trace several Hepatitis B patients back to a barber who transmitted the disease to them by shaving all the patients with the same razor. While the barber had actually used a disinfectant, it was not strong enough to kill all the germs.
It has been observed that many of the serious blood-borne diseases such as HIV/AIDS, Hepatitis B and C, which plague us today were less prevalent some years Back. Medical researchers have reported that about forty million people are currently living with the HIV-Virus. A significant number of these cases have no known cause!
The question is, "Could poorly trained beauty therapists and barbers using dirty and unsterilized or improperly sterilized instruments be inadvertently spreading these diseases?"
A closer look at beauty salons and barbershops reveals that sanitary practices are unsatisfactory and sometimes unethical. And this can serve as a very effective transmission route for serious blood borne diseases like HIV/AIDS, and Hepatitis.
Evidence based scientifically reports that razors, nail files, barber's scissors, tattoo needles, and body piercing Instruments are risk factors for transmitting HIV/AIDS, Hepatitis B and C.
Precautionary steps
The best methods of sterilization are steam, ethylene oxide gas, dry heat and use of chemical germicides such as bleach. Steam for example can only take care of some bacteria simply by inactivating them, while some hardened bacteria species can withstand the steam. Steam definitely will not work on a virus like HIV which has the capability to withstand temperatures as high as 40° C, but chemicals like bleach will inactivate the virus. To play safe, take your personal beauty kit or dippers to the salon.
Another precautionary method is the use of latex gloves. Though beauty therapists rarely wear them; they are advisable for protecting you from any ailments from a previous client. Many professionals practice what is referred to us "UNIVERSAL PRECAUTIONS" which means you assume all bodily fluids are blood as well as that all tissues are infectious until proven otherwise. The main way this is achieved is by the use of latex gloves. So next time when you go to a salon and the beauty therapist is wearing a Latex glove, do not be alarmed, it is for your own good.
The spread of the disease
In 1989, a Medical researcher found that Hepatitis C could be transmitted via Razors commonly used in barbershops to trim sideburns. The researcher soaked Razors from five different barber's shops into five commonly used sterilizing solutions. The result showed none of the five solutions destroyed Hepatitis C, even though some were soaked for six hours, twenty-four hours and even up to seven days!! Other research shows that Hepatitis B can survive outside the body for seven days or more on chairs, head rests, work benches, instruments and tools. Cuts, nicks and scrapes at the beauty salon can also lead to other less deadly medical conditions which include; Warts bacterial-fungus infections, reactions to various products and fumes for both clients and shop operators.
Reducing the risk
As earlier mentioned the risks would be virtually eliminated, if beauty therapists and barbers alike learnt to use disposable instruments, wore rubber gloves, washed their hands properly and used appropriate sterilization techniques.
The writer is the volunteer working with Nyagatare Hospital, Nigeria Tech and corps.
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Study Finds No Crime Increase around Vancouver Injection Site
http://seattlepi.nwsource.com
The Associated Press
VANCOUVER, British Columbia -- A safe injection site for drug addicts to shoot up under medical supervision has not brought more crime or attracted drug dealers or users from other jurisdictions, according to a police-commissioned study.
The report by Irwin M. Cohen, a criminologist commissioned to examine the site for the Royal Canadian Mounted Police, is expected to be considered by Prime Minister Stephen Harper before he decides whether to renew a legal exemption for Insite from a section of the Controlled Drugs and Substances Act.
Insite, located in the Downtown Eastside slum between the downtown area and Chinatown, is run by Vancouver Coastal Health Authority under a Health Canada exemption that expires Sept. 12.
"Some of the major concerns by those who were not in favor of supervised drug injection sites have not borne out - this idea that if we cluster drug users in a very specific area around this site you're going to have public nuisance increases, you're going to have crime increases," wrote Cohen, a professor at University College of the Fraser Valley.
Backers, including some health experts, have touted the site for reducing the spread of AIDS, which is often transmitted by drug users sharing hypodermic syringes.
Harper, who has not attended an international AIDS conference this week in Toronto, said in May he was waiting for evaluations from the Mounties and other agencies before deciding whether to extend the exemption.
In a separate study, Raymond R. Corrado, a criminologist at Simon Fraser University, reviewed 25 English peer-reviewed journal articles and United Nations-commissioned reports on injection sites in Australia, Germany, Spain, Switzerland and the Netherlands, and applied those findings to the experience to date in Vancouver.
"I would say from a research perspective, not from a citizen's perspective, the experiment should continue," Corrado said.
Dr. Thomas Kerr, an associate professor of medicine at the University of British Columbia and research scientist at the British Columbia Centre for Excellence in HIV/AIDS, said crime actually has declined in the drug-infested Downtown Eastside since Insite opened there.
"We've published a study in the Canadian Medical Association Journal showing that the establishment of the site led to substantial reductions in public disorder," Kerr said. "We did see a reduction in car break-ins in the neighborhood."
Tony Lam, president of the Vancouver Chinatown Business Improvement Association, said merchants in the historic neighborhood noticed drug activity is much quieter since the site opened.
"They don't get together in the back lanes or under the stairways to get injections, so the outside look of Chinatown is much (more) peaceful than before," Lam said.
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August 16th, 2006
Racial Differences in Hepatitis C Viral Responses
http://www.news-medical.net/
African American patients with hepatitis C (HCV) infections experience a lower response rate to the peginterferon alfa-2a and ribavirin combination treatment than Caucasian Americans*, according to a study published in the August issue of Gastroenterology, the journal for the members of the American Gastroenterological Association (AGA).
Racial differences in viral responses were seen as early as the fourth week of treatment. A pegylated interferon combined with ribavirin is standard therapy for HCV.
Researchers from the Study of Viral Resistance to Antiviral Therapy for Chronic Hepatitis C (Virahep-C), which is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), conducted the study to determine the potential mechanisms of antiviral resistance among patients who fail to respond to current optimal therapy regimens. While African Americans have a higher prevalence of HCV infection, they have been underrepresented in most therapeutic clinical trials, making it difficult to estimate response rates in these patients.
According to Charles Howell, MD, associate professor of medicine, University of Maryland School of Medicine and chairperson of the Virahep-C Study Group Steering Committee, "The basis for the racial difference in virologic response rates is being addressed by ongoing supplementary studies in genetics, immunology, interferon signaling and pharmacology, and virology. However, our study results indicate that the reduced response rate among African American patients is not caused by the usual predictors such as patient age, gender, pretreatment serum HCV concentrations, amount of fibrosis in the liver biopsy nor amount of medication taken."
Study results showed that sustained virologic response (SVR), the primary endpoint, was significantly lower in African Americans compared with Caucasians (28 percent vs. 52 percent; P<.0001). Patients with SVR had not shown evidence of HCV RNA in their blood 24 weeks after the end of treatment. At treatment week 24, 46 percent of African Americans compared with 74 percent of Caucasian patients were HCV RNA negative and were eligible to continue on therapy to 48 weeks. While breakthroughs in virologic response during treatment were more common among African Americans than Caucasian patients (13 percent vs. 6 percent), the relapse rates after treatment were comparable (32 percent vs. 25 percent).
Data indicated that the proportion of the total maximum dose taken of both peginterferon and ribavirin during the first 24 weeks of treatment was significantly less in African Americans versus Caucasian patients; 54 percent of African American patients compared with 73 percent of Caucasian patients took at least 80 percent of the maximum doses of both peginterferon and ribavirin (P<.0001). However, this did not account for the racial difference in SVR rates.
African American and Caucasian patients experienced similar serious adverse events, dose reductions and drug discontinuations. Three deaths were included in the serious adverse events for African American patients - two deaths were considered unrelated after therapy had stopped, and one death occurred during therapy, possibly related to the peginterferon treatment.
Study Design Patients were treated for up to 48 weeks with peginterferon alfa-2a (Pegasys.) 180 5g/wk and ribavirin (Copegus.) 1000 or 2000 mg/day based on body weight of 75 kg or less. Patients were monitored at one to two week intervals for the first eight weeks, then every four weeks through the end of the study. Virologic response was assessed at week 24, and treatment was stopped in patients who had a positive test for serum HCV RNA. Responders continued treatment for another 24 weeks and were assessed for sustained virologic response at 24 weeks after treatment completion.
The study enrolled 401 patients (196 African Americans and 205 Caucasian Americans) who were treated at eight U.S. clinical centers between July 2002 and December 2003. Both groups were similar in terms of sex, age, estimated duration of infection, suspected source of infection and alcohol use. African American patients had a higher body weight and were more likely to have a history of diabetes and hypertension. African Americans were also more likely to have genotype 1b and less likely to have genotype 1a.
According to a second study published in the August issue of Gastroenterology, "non-Hispanic black race [is] the important predictor of genotype 1, and among persons infected with subtypes 1a and 1b, older age and non-Hispanic black race were the important predictors of genotype 1b...genotype1 and non-Hispanic black race, have been associated with a reduced response to antiviral therapies."**
Hepatitis C Surveys indicate that 1.3 percent of the U.S. population, approximately 3.2 million Americans, have chronic HCV. Chronic HCV is the leading cause of chronic liver disease and the most common indication for liver transplants in the U.S. HCV-related cirrhosis (disruption of normal liver function caused by various chronic progressive conditions) accounts for almost 50 percent of newly diagnosed liver cancers and approximately 10,000 deaths per year.
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*Conjeevaram H, Fried M, Jeffers L, Terrault N, Wiley-Lucas T, Afdhal N, Brown R, Belle S, Hoffnagle J, Kleiner D, Howell C. Peginterferon and Ribavirin Treatment in African American Patients and Caucasian American Patients with Hepatitis C Genotype 1. Gastroenterology 2006; 131:470-477.
**Nainan O, Alter M, Kruszon-Moran D, Gao F-X, Xia G, McQuillan G, Margolis H. Hepatitis C Virus Genotypes and Viral Concentrations in Participants of a General Population Survey in the United States. Gastroenterology 2006;131:478-484.
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A Breeding Ground for Communicable Disease
http://www.thestar.com
JOSEPH HALL
STAFF REPORTER
Needle exchange program urged HIV affects 2% of adult inmates
Jim Motherall figures there were only seven to 10 usable needles making the rounds of Manitoba's Stony Mountain Institution at any one time during his 19 1/2 years inside the federal penitentiary.
He calculates that more than 200 drug-using inmates would typically be sharing them.
"So there was at least 20 guys on a syringe," says Motherall, who has spent a total of 32 years behind bars for myriad violent crimes and has spoken widely on prisoners' health issues.
"And if one of those 20 had HIV and they're sharing a syringe, then it's just going on down the line."
A University of Toronto study of Ontario prisoners presented at the International AIDS Conference in Toronto this week estimates that 2 per cent of the province's adult inmates are HIV-positive, or about 1,000 prisoners during the study years of 2003 and 2004. (The rate for hepatitis C among adult prisoners in Ontario was 17.6 per cent, the study found.)
To contrast, just 0.2 per cent of the Canadian population is infected with the AIDS-causing virus.
Several researchers and inmate advocates told the conference that corrections authorities were failing prisoners badly by offering no credible HIV/hepatitis prevention program in jails and prisons.
With no prisoner needle-exchange programs running anywhere in Canada, and badly flawed condom and safe-tattooing programs, prisons have become breeding grounds for communicable blood diseases like AIDS and hepatitis C, scientists and prison advocates warn.
"If there was as much HIV and hepatitis C transmission in Canada as a whole as there is in Canadian prisons, there would be a public outcry and Canada would have the worst AIDS problem in the developed world," Joanne Csete, executive director of the Canadian HIV/AIDS Legal Network, told a news briefing yesterday.
"People expect the sentences that are handed down by the courts, but they shouldn't have to have a life sentence of HIV or hepatitis C," she said in an interview.
The U of T report, titled Prevalence and Risk Factors for HIV and Hepatitis C in Ontario Jails and Detention Centres, says injection drug use is by far the biggest culprit in the spread of both diseases among provincial prisoners.
It's estimated that 30 to 50 per cent of prisoners in Ontario have a history of injection drug use. And the report says studies in Ontario and Quebec show that 5 to 8 per cent of inmates in those provinces have admitted to injecting drugs while behind bars. In male federal prisons, the drug injection rate, as reported by prisoners themselves, has reached 24 per cent.
Yet nowhere in the country is there a program that gives inmates access to clean needles, advocates told the conference.
Free-needle programs offered inside jails by a handful of liberal European countries — as well as in some repressive states like Iran — have led to huge declines in HIV transmission between prisoners, Csete says.
In Switzerland, a long-standing prison needle program has virtually eliminated transmission of HIV and hepatitis in jails.
"It's stunning — you really can stop it," Csete says. "There are all kinds of ways you can do these things, and they're extraordinarily effective. And unlike condoms, where you have to convince people to wear them, people who inject drugs want to have clean needles."
Csete says there has never been a reported incident of needles being used as weapons in prison. And even if such an incident occurred, a clean needle would be preferable.
Canadian programs for dispersing condoms behind bars have also been criticized.
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ViroPharma and Wyeth Planning Phase II Hepatitis Trials
http://www.pharmaceutical-business-review.com
By Helen Marshall
Having achieved a 'proof of concept' milestone in a phase Ib study, ViroPharma Incorporated and Wyeth have announced that they are preparing to initiate a phase II clinical trial of their investigational hepatitis C antiviral HCV-796.
The two companies have revealed that, while the analysis of data from their phase Ib study of HCV-796 plus pegylated interferon is still ongoing, data analyzed to date indicate that the drug candidate has achieved a proof of concept milestone under the companies' agreements.
ViroPharma and Wyeth expect that preliminary data from the phase Ib study will be available for release by the end of August 2006. Based upon the preliminary data reviewed to date, the two firms are preparing to initiate phase II combination studies of HCV-796. They expect to begin dosing patients in the phase II study in the fourth quarter of 2006.
In connection with meeting the proof of concept milestone, ViroPharma will issue to Wyeth 981,836 shares of ViroPharma's common stock for a purchase price of $10 million, representing the last of three stock purchases outlined in the companies' agreements.
"With HCV-796, we now have for the first time in our collaboration a unique compound with a novel mechanism of action that has achieved proof of concept in combination with pegylated interferon," commented Dr Robert Ruffolo, Wyeth Pharmaceutical's president of research. "We are excited to reach this milestone and to be collaborating with ViroPharma to move this promising compound toward phase II trials."
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Hepatitis B Health Alert!
http://www.soonews.ca/
Press Release
The Algoma Health Unit would like to inform the residents of Algoma that we are noting an increase in the number of cases of acute hepatitis B.
Hepatitis B is a viral disease that affects the liver. Symptoms include jaundice or yellowing of the skin, weakness, vomiting, mild fever, abdominal discomfort, achy joints and rashes and in some cases, people will have no symptoms at all.
Hepatitis B is spread in the following ways:
• Sexual contact with an infected person.
• Contact with infected blood (need a route of entry like a crack in the skin).
• Sharing needles.
• Sharing toothbrushes or razor blades.
• Receiving a bite from an infected person.
• Body piercing or tattooing. Always ensure the artist uses a new needle, straight out of the package.
Engaging in these activities also puts you at risk for other blood borne illnesses such as hepatitis C, HIV and sexually transmitted infections.
Hepatitis B is not spread by water, food or by casual contact that occurs at most schools or workplaces.
“You can prevent yourself from contracting hepatitis B,” explains Liisa Daoust, a public health nurse at the Algoma Health Unit. “Do not have unprotected sex, especially with people who have multiple partners, practice safer sex by using a latex condom all the time and if you are an IV drug user, use clean needles all the time and take advantage of the free needle exchange program.”
Some people may be eligible to receive a free hepatitis B vaccine. If you belong to one of the following groups, you are eligible for the free vaccine:
• Intravenous drug users
• Multiple sex partners
• Have a recent history of a sexually transmitted infection
• Have hepatitis C
The hepatitis B vaccine is offered to all grade 7 students in Algoma. Public health nurses go into the school setting and administer the vaccine to consenting students in a series of two shots.
This week, health unit staff will be placing posters in area bars/restaurants promoting steps people can take to protect themselves. “We are being very proactive in our outreach by visiting local establishments,” explains Daoust.
To book an appointment for the hepatitis B vaccine, please call (705) 541-7085.
If you have any questions or concerns about hepatitis B, please call the Infection Control program at the Algoma Health Unit at (705) 759-5285 or visit us online at www.ahu.on.ca
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August 17th, 2006
Proton Beams Control Liver Tumors
http://www.reutershealth.com/
By David Douglas
NEW YORK (Reuters Health) - Patients with liver tumors called hepatocellular carcinomas and who have few other treatment options are likely to benefit from proton beam radiation therapy, Japanese researchers report in the journal Cancer.
Lead investigator Dr. Masaharu Hata told Reuters Health: "Proton beam therapy was given safely and effectively to a wide spectrum of patients with hepatocellular carcinoma."
Hata and colleagues at the University of Tsukuba took a look back at 21 patients with liver tumors for whom other treatment modalities were contraindicated or not feasible because of coexisting diseases such as severe cirrhosis, kidney failure, and severe heart disease.
Seven of the patients had multiple liver tumors. The median tumor diameter was 40 mm. No patients had regional or distant metastases.
At a median of 3.3 years after proton beam radiation, all but one of the tumors was controlled. At 5 years, the objective response rate was 81 percent and the primary site control rate was 93 percent.
Four of 11 patients who developed recurrent liver tumors had a second course of proton beam therapy, which controlled the tumors.
At 5 years, overall survival was 33 percent and cause-specific survival was 67 percent.
Proton beam therapy was well tolerated.
"The results suggested that this method was tolerable and effective," concluded Hata, "even for patients who had severe coexisting diseases or unfavorable conditions for whom other treatment modalities were contraindicated or unfeasible."
Cancer August 2006.
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High Hep C Contamination of Toothbrushes
www.gastrohep.com
There is a considerable portion of Hepatitis C-RNA contamination of toothbrushes used by Hepatitis C patients, reports this month's Journal of Viral Hepatitis.
Chronic Hepatitis C patients are advised not to share toothbrushes, razors, nail-scissors or other personal articles that may have been in contact with others.
Dr Lock and colleagues from Germany examined the contamination of toothbrushes with chronic Hepatitis C.
The researchers assessed this as a model for a possible unconventional way of transmission.
The team tested in 30 patients with chronic hepatitis C, 2 mL of saliva, and the toothbrush rinsing water after toothbrushing for Hepatitis C-RNA.
Saliva before and after toothbrushing was positive for Hepatitis C-RNA in 9 and 11 patients, respectively.
The researchers found that 12 of the toothbrush rinsing water specimens tested Hepatitis C-RNA-positive.
12 of the toothbrush rinsing water specimens tested Hepatitis C-RNA-positive – Journal of Viral Hepatitis
In 6 of these 12 patients, the team noted that 'native' saliva had been negative for Hepatitis C-RNA.
Patients with Hepatitis C-RNA-positive toothbrush rinsing water showed no significant differences from those with negative rinsing water.
The research team found no differences with respect to certain clinical, biochemical and virological parameters.
Dr Lock's team concluded, “Our study demonstrates a contamination with Hepatitis C-RNA of a considerable portion of toothbrushes used by Hepatitis C patients.”
“This suggests at least a theoretical risk of infection by sharing these objects and strengthening the recommendations to take care of a clear separation of these personal care objects between patients and their household members.”
J Viral Hep 2006: 13(9): 571
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'Postcode Lottery' for Disease Victims
http://icliverpool.icnetwork.co.uk
By Rob Merrick, Daily Post
A "POSTCODE lottery" facing thousands of Merseyside and Cheshire victims of a virus that causes chronic liver disease has been condemned by MPs.
Several primary care trusts (PCTs) in Wirral and Warrington were praised for implementing an action plan to tackle the growing threat from hepatitis C.
But other PCTs, including those covering Southport and St Helens, were accused of doing little or nothing to implement Department of Health guidelines.
The MPs also expressed suspicion that PCTs that failed to respond to their inquiry, including those in Liverpool and Knowsley, probably had very poor services.
If untreated, the hepatitis C virus - most often spread through sharing needles to inject drugs - can cause cirrhosis, liver failure, or liver cancer.
At least 200,000 people countrywide are thought to be infected, but the virus can go undetected for years because it often produces no early symptoms.
The all-party hepatology group of MPs sent a questionnaire to every PCT, asking what information it had on the scale of its hepatitis C problem and what services it offered.
The 63% that responded were then ranked on their responses, with a score of three or fewer points designating a PCT that "has not done nearly enough".
Between four and seven meant the action plan had been partly applied, while any PCT that had made "significant progress" scored eight or higher.
Across Merseyside and Cheshire, PCTs in Bebington & West Wirral (9), Birkenhead & Wallasey (9) and Warrington (8) all scored very highly.
But Ellesmere Port & Neston and Cheshire West scored just three, while Southport & Formby and St Helens were given the lowest score - just one.
None of the three Liverpool PCTs, South Liverpool, Central Liverpool and North Liverpool, responded to the inquiry. Nor did Knowsley or South Sefton.
The report noted that PCTs which had few services to describe would have found it more time-consuming to fill in the questionnaire.
And it concluded: "There must be the suspicion that it is precisely those trusts that have done the least to implement the action plan that are the most likely not to have responded."
The report demands a more detailed government strategy, a single leader to oversee it, and more effort to raise awareness and improving testing.
It also calls for specialist centres to be set up, as they have been in France, Germany and Italy, to provide diagnosis and treatment.
A Department of Health spokeswoman said awareness campaigns and the action plan were having an impact, as more people were being diagnosed.
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Occult Hepatitis B Patients at High Risk of Fulminant Hepatic Failure after Chemotherapy
http://english.people.com.cn
The University of Hong Kong announced Wednesday a study result saying that occult Hepatitis B infected patients are likely to develop fulminant hepatic failure after chemotherapy.
A research team at the Faculty of Medicine of the university carried out a study which involve 244 lymphoma patients with occult Hepatitis B virus (HBV) receiving chemotherapy. The result shows that 40 percent of the patients suffer from fulminant hepatic failure after chemotherapy.
According to researchers, lymphoma patients, who are occult HBV positive, are more likely to have HBV-related hepatitis after chemotherapy and have a higher chance of developing fulminant hepatic failure.
They recommended that occult HBV infected patients should be monitored closely for relapse HBV-related hepatitis so that early treatment with nucleoside or nucleotide analogues can be initiated.
The study result has been published in the leading international medical journal Gastroenterology in July 2006.
Source: Xinhua
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African-Americans Have a Reduced Response to Hepatitis C Treatment
http://www.medindia.net
According to a new study by Duke University Medical Center researchers, African-Americans have a notably lower response in the rate of treatment for chronic hepatitis C than non-Hispanic whites.
The researchers had reported in the August issue of Gastroenterology, which is the journal for the members of the American Gastroenterological Association (AGA), that the African American patients with hepatitis C (HCV) infections experience a reduced response in the rate in treatment with peginterferon alfa-2a and ribavirin combination treatment than Caucasian Americans. They explained that the so-called racial differences in viral responses might be seen as the fourth week of treatment. It was further explained that pegylated interferon combined with ribavirin is standard therapy for HCV.
Researchers from the Study of Viral Resistance to Antiviral Therapy for Chronic Hepatitis C (Virahep-C), which is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), conducted the study to determine the potential mechanisms of antiviral resistance among patients who fail to respond to current optimal therapy regimens. While African Americans have a higher prevalence of HCV infection, they have been underrepresented in most therapeutic clinical trials, making it difficult to estimate response rates in these patients.
According to Charles Howell, MD, associate professor of medicine, University of Maryland School of Medicine and chairperson of the Virahep-C Study Group Steering Committee, "The basis for the racial difference in virologic response rates is being addressed by ongoing supplementary studies in genetics, immunology, interferon signaling and pharmacology, and virology. However, our study results indicate that the reduced response rate among African American patients is not caused by the usual predictors such as patient age, gender, pretreatment serum HCV concentrations, amount of fibrosis in the liver biopsy nor amount of medication taken."
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August 18th, 2006
Hep C Activist Dies at 48
http://www.cbc.ca
CBC News
Neil Van Dusen, an outspoken victim of Canada's tainted blood scandal, died Monday of complications from hepatitis C. He was 48.
Neil Van Dusen died Monday from complications related to hep C. (CBC) Van Dusen, who was from Lower Sackville, N.S., was a hemophiliac who contracted the disease from a blood transfusion in the 1980s.
He was living in Cape Breton when he learned he got hepatitis C from unscreened blood products.
It prompted him to lobby for compensation for his family and hundreds of others. His older brother, Eric, also a hemophiliac, died after getting HIV from his blood treatment.
Between 1989 and 2005, the federal government agreed to provide more than $1 billion to about 6,200 people — including Van Dusen — who received tainted blood products between 1986 and 1990.
And last month, Ottawa announced another $1-billion settlement for 5,500 people who contracted hepatitis C before 1986 and after 1990.
In a letter to the Chronicle Herald newspaper, Van Dusen said he was both satisfied and saddened by the government's latest move, but also hopeful a cure would be found.
"The tainted blood scandal has taken a lot away from us — our health, our dignity, and our loved ones — but the one thing it can’t take away is our hope," he wrote.
"I am beyond bitter over this issue, yet don’t dwell on the past. It’s the future I look forward to, no matter how long that may be."
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Reports from Spain, the United States and Italy Describe Recent Advances in Hepatitis C Virus Research
http://www.therapeuticsdaily.com
Health & Medicine Week - Aug. 21, 2006
Data on hepatitis C virus are outlined in reports from Spain, the United States and Italy.
Study 1: Recent research from Spain has reported on a new subtype of hepatitis C virus (HCV) genotype 1.
"HCV is the leading cause of chronic liver disease and is associated with hepatocellular carcinoma. However, there have been few studies on the distribution and genetic diversity of HCV isolates in non-developed countries.
"Here, the complete genome sequence of an HCV genotype 1 isolate from Equatorial Guinea is reported, the first complete HCV-1 genome of African origin," wrote M.A. Bracho and colleagues, University of Valencia.
"Phylogenetic analysis revealed that this sequence always grouped with sequences of genotype 1, but did not group clearly with any subtype described so far. An analysis of partial NS5B gene sequences with additional sequences of African origin also failed to find close similarities between the new sequence and any previously known isolate.
"Genetic divergence of the coding region of this new sequence with respect to the recognized subtypes of HCV-1 ranged from 20 to 22%," the authors reported.
The researchers concluded, "It is proposed that this isolate is a representative of a new, distinct variant of HCV subtype 1."
Bracho and colleagues published their study in the Journal of General Virology (A new subtype of hepatitis C virus genotype 1: complete genome and phylogenetic relationships of an Equatorial Guinea isolate. J Gen Virol, 2006;87(Part 6):1697-1702).
For additional information, contact M.A. Bracho, University of Valencia, Institute Cavanilles Biodiversitat & Biology Evolution, E-46070 Valencia, Spain.
Study 2: Recent research from the United States has reported on the identification of a hepatitis C virus (HCV)-reactive T cell receptor that does not require CD8 for target cell recognition.
"HCV has been reported to elicit B and T cell immunity in infected patients. Despite the presence of antiviral immunity, many patients develop chronic infections leading to cirrhosis, hepatocellular carcinoma, and liver failure that can require transplantation," wrote G.G. Callender and colleagues, University of Chicago.
"We have previously described the presence of HLA-A2-restricted, HCV NS3-reactive cytotoxic T lymphocytes (CTL) in the blood of HLA-A2- liver transplantation patients that received an HLA-A2+ liver allograft. These T cells are analogous to the 'allospecific' T cells that have been described in hematopoietic stem cell transplantation patients.
"It has been speculated that allospecific T cells express high-affinity T cell receptors (TCRs). To determine if our HCV-reactive T cells expressed TCRs with relatively high affinity for antigen, we identified and cloned a TCR from an allospecific HLA-A2-restricted, HCV-NS3:1406-1415-reactive CD8+ T cell clone and expressed this HCV TCR in Jurkat cells," wrote the researchers.
"Tetramer binding to HCV TCR-transduced Jurkat cells required CD8 expression, whereas antigen recognition did not," the scientists continued.
They concluded, "Based on the reactivity of the TCR-transduced Jurkat cells, we have identified a TCR that transfers anti-HCV reactivity to alternate effectors. These data suggest this high affinity HCV-specific TCR might have potential new immunotherapic implications."
Callender and colleagues published their study in Hepatology (Identification of a hepatitis C virus-reactive T cell receptor that does not require CD8 for target cell recognition. Hepatology, 2006;43(5):973-981).
For additional information, contact M.I. Nishimura, University of Chicago, 5841 S Maryland Avenue, MC 7116, Chicago, IL 60637, USA.
Study 3: According to a study from Italy, hepatitis C virus (HCV)-associated lymphoproliferative disorders involve differing increases of interleukin (IL) inhibitors.
"HCV causes hepatitis, liver cirrhosis and hepatocellular carcinoma, and may also induce type II mixed cryoglobulinemia syndrome (MC), a disease characterized by clonal B-cell lymphoproliferations that can evolve into non-Hodgkin lymphoma (NHL)," wrote M. Libra and colleagues, University of Catania.
They continued, "IL-1 is a cytokine that plays an important role in initiating the cascade of events of immunoinflammatory responses through costimulation of T lymphocytes, B-cell proliferation, induction of adhesion molecules and stimulation of the production of other inflammatory cytokines."
"The role of IL-1 in immuno-inflammatory responses is highlighted by the presence of endogenous regulators (IL-1 receptor antagonist, soluble receptors type I and II, human IL-1 accessory protein) that, when secreted into the blood stream may serve as endogenous regulators of IL-1 action. The aim of this study was to evaluate whether abnormalities in the blood levels of IL-1 beta IL-1 receptor antagonist, soluble IL-1 receptor type II and human IL-1 accessory protein in HCV+ patients are associated with development of MC and/or NHL," the investigators explained.
"Relative to healthy controls, we observed: i) an increase in the circulating levels of IL-1 beta in HCV+ patients simultaneously affected by NHL; ii) increased levels of IL-1 accessory protein in patients singly infected by HCV; iii) increase of IL-1 receptor antagonist in HCV+ patients and in those affected also by NHL with or without MC; iv) a homogeneous increase of sIL-1R type II in all the subgroup of patients," wrote the researchers.
They concluded, "These data indicate that an attempt to increase circulating levels of IL-1 inhibitors occurs at different extent in the course of HCV infection as well as in its progression to NHL and/or MC."
Libra and colleagues published the results of their research in Oncology Reports (Analysis of interleukin (IL)-I beta IL-1 receptor antagonist, soluble IL-1 receptor type II and IL-1 accessory protein in HCV-associated lymphoproliferative disorders. Oncol Rep, 2006;15(5):1305-1308).
For additional information, contact M. Libra, University of Catania, Department of Biomedical Science, Via Androne 83, I-95124 Catania, Italy.
This article was prepared by Health & Medicine Week editors from staff and other reports.
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