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Week Ending: March 17th , 2007
Alan Franciscus
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March 12th , 2007
Predictors of Treatment Prescription for Hep C
www.gastrohep.com
Hep C non-treatment is associated with increasing age, race, drug and alcohol abuse, and comorbid illnesses, reports the latest issue of Gut.
The true treatment rate for Hepatitis C virus in veterans is unknown.
Dr Adeel Butt and colleagues from Pennsylvania determined treatment prescription rates and predictors of prescription for Hepatitis C virus in a large national population.
The research team used the department of veterans affairs national patient care database.
The treatment prescription rate for Hepatitis C virus was 12%--Gut
The team identified all Hepatitis C virus-infected people between the fiscal years 1999 and 2003 using the International classification of diseases, 9th revision codes.
Demographic information, medical and psychiatric comorbidities, and drug and alcohol use diagnoses were retrieved.
The research team retrieved pharmacy data from the department of veterans affairs pharmacy benefits management database.
The researchers used logistic regression analysis to determine the predictors of treatment for Hepatitis C virus.
The researchers identified 113,927 veterans in the department of veterans affairs care with a diagnosis of Hepatitis C virus.
The treatment prescription rate for Hepatitis C was 12%.
The team found that patients not prescribed treatment were older, and more likely to be from minority races.
Patients not prescribed treatment also had more alcohol and drug misuse, and medical and psychiatric comorbid conditions.
In a multivariate logistic regression model, the team identified several predictive factors of non-treatment for Hepatitis C.
Increasing age, Black race, Hispanic race, alcohol abuse and dependence were predictive of non-treatment for Hepatitis C.
The team observed that drug abuse and dependence, anemia, Hepatitis B infection, coronary artery disease were predictive of nontreatment.
Stroke, bipolar disorder, major and mild depression, and schizophrenia predicted non-treatment.
The researchers found several factors associated with a higher likelihood of treatment prescription for Hepatitis C virus.
These included liver cirrhosis, and diabetes.
Dr Butt's and team concluded, “A small number of Hepatitis C virus-infected veterans were prescribed treatment for Hepatitis C virus.”
“Non-treatment is associated with increasing age, non-white race, drug and alcohol abuse, and dependence and comorbid illnesses.”
“Reasons for non-treatment need further study.”
Gut 2007: 56(3): 385-89
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Veterans News Report
http://www.moberlymonitor.com
Each hour of every day, three people die from Hepatitis C or itls related conditions. Two of three people have military backgrounds. A study by the Veterans Health Administration (VHA) involving 26,000 veterans showed that up to 10% of all veterans in the VHA system tested positive for hepatitis C, while the infection rate on the general population is only 1.8%.
The hepatitis C virus is a blood borne disease that attacks the liver. In 85% of the cases, the infection will last a lifetime. This puts a person at risk for developing cirrhosis of the liver, liver cancer, and even death. Many people don't know they are infected because there are no symptoms at first. However, hepatitis C can slowly progress to cirrhosis over many years.
Many ways of getting infected have been identified. Combat and even military training often bring soldiers into contact with blood. Exposures to bleeding wounds or transfusions are ways you may become infected. Tattoos, sexual contact, or injection or snorting of drugs are other possible risks.
Of the total number of persons who were hepatitis C antibody positive, and reported an era of service, 62.7% were from the Vietnam war. The second most frequent group is listed as post-Vietnam at 18.2%, followed by 4.8% Korean conflict, 4.3% post-Korean conflict, 4.2% from World War II and 2.7% Persian Gulf era veterans. It has been estimated that at least 36,000 soldiers transfused in Vietnam received infected blood.
Typical symptoms are abdominal discomfort, loss of appetite, nausea, vomiting, fatigue and weight loss, and sometimes yellowing of the skin and eyes. Symptoms can range from mild to severe. However, 75% of infected persons may have no symptoms at all.
If you have hepatitis C, there are important things you can do to help prevent spreading hepatitis C to your loved ones and other individuals. Unfortunately, most of the 4 million Americans infected have not been diagnosed, and thus do not know that they have hepatitis C. The sooner you know if you are infected, the sooner you can take steps to safeguard your health. You protected your country, now protect yourself if you have hepatitis C. If you have any questions, or want more information about hepatitis C contact your health care professional, or your VA medical center.
This information has been presented by The American Legion in conjunction with your local American Legion Post.
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Exchange Programs Help Prevent AIDS, Hepatitis C
http://www.toledofreepress.com
By Stephen Roberts
We face many complex challenges, such as global warming, aging baby boomers, potential pandemics and the decreasing availability of oil. Coping with these issues will require intelligence, cooperation and an ability to challenge some of our established beliefs.
The strategies presently used in the United States to cope with our drug problems do not give me a lot of hope. A significant number of us think drug abusers are immoral and undesirable rather than sick people in need of treatment. Because of these entrenched negative beliefs, we do not treat abusers in the most effective and compassionate manner. An example of our ineffective behavior is withholding clean needles from injecting drug users (IDUs). Withholding clean needles does not positively impact the drug problem and instead contributes to needless death, disease transmission and increased health care costs.
As of 2004, injection drug use causes 20 percent of the 40,000 HIV/AIDS cases and 60 percent of the 26,000 hepatitis C infections that occur in the United States each year. IDUs become infected and then spread disease through sharing syringes or risky sexual behavior. Evidence indicates that if we established syringe exchange programs (SEPs) across the country, we could significantly decrease the spread of HIV/AIDS and hepatitis C to drug users and many others, including family members and children.
Syringe exchange programs distribute clean syringes to drug addicts who exchange used needles that may be infected with disease. These exchange programs often provide access to education, treatment, screening and primary medical services.
Earlier work indicates that syringe exchange programs, as well as saving lives and preventing the spread of disease, can save significant dollars. In the 1990s it was estimated SEPs had an average annual budget of $169,000 while the lifetime cost of treating one person with AIDS was more than 100,000. If in a year's time an SEP prevented two cases of AIDS, it would pay for itself.
A study reported in the journal Lancet indicates approximately 7,200 AIDS cases could have been prevented between the years 1987 and 1995 if SEPs had been established. This would have saved more than $500 million in health care costs.
Several studies show SEPs do not increase drug use among present-day users or increase the number of first-time users.
According to Kristen Tobias, the only needle exchange program in Ohio is at the Free Clinic of Greater Cleveland. Tobias, who administers this SEP, said the program exchanges clean needles for used ones with a very wide range of clients, including 75-year-old grandmothers and Toledo drug users who make the drive to Cleveland.
If needle exchange programs save lives, prevent AIDS and hepatitis C transmission, save money and do not increase the number of drug users, logic would indicate, as it has to the other industrialized countries, that we set up many more needle exchange programs across the country. We haven't. Hopefully, clearer thinkers are working on the warming, oil and pandemic problems.
Stephen Roberts is an associate professor in the UT Department of Public Health and Homeland Security.
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Neglect of Hepatitis C Leaves People with HIV Vulnerable
http://theseoultimes.com
By Bobby Ramakant
Public Health Writer
In communities where sharing of injection equipment drives the HIV epidemic, a parallel epidemic often lurks quietly in the shadows. Greater awareness about hepatitis C, more investment of resources, cheaper diagnostic and treatment services, and improved hepatitis-related treatment literacy, are all urgently needed by people co-infected with the hepatitis C virus and HIV.
"Hepatitis C treatment is mostly left out since AIDS activists are so focused on ARVs [antiretroviral drugs] or other prevention and treatment services," said Umesh Sharma, who has just completed a course of hepatitis C treatment.
Hepatitis C is a blood-borne, infectious, viral disease that is caused by the hepatitis C virus (HCV). The infection can cause liver inflammation that is often asymptomatic, but chronic hepatitis can lead to cirrhosis and liver cancer. HCV transmission occurs when traces of blood from an infected person enter the body of a HCV-negative person. Like HIV, HCV is spread through sharing injection equipment, through needle stick or other sharps injuries, or less frequently from infected mothers to their babies.
HCV transmission rates are higher than that of HIV, and the condition is often more severe in drug users. People who share injection equipment are vulnerable to HCV and HIV infection, and in many places co-infection is not common.
For Umesh the key was largely having access to the information he needed. Already aware of his positive HIV status, he went for a routine general health check-up during a trip to London in 1995. He discovered he was also infected with HCV. Until then he had no symptoms of HCV. This is not an unusual story, up to 80% of people with HCV usually develop no symptoms. Initial symptoms, when they appear, can include jaundice, fatigue, dark urine, abdominal pain, loss of appetite and nausea.
There are three types of tests for HCV, which all use polymerase chain reaction (PCR) technology:
- HCV PCR viral detection test: This qualitative test is designed to detect the hepatitis C virus.
- HCV PCR viral load test: This quantitative test estimates the level of HCV in the blood. It helps to monitor the effectiveness of treatment.
- HCV PCR genotype test: This determines the specific genotype (genetic 'make-up') and subtype of HCV. This information is important in selecting a course of treatment. For example, treatment with interferon is more often effective for people with HCV genotype 2 or 3.
"The cost of these PCR tests is prohibitive," says Umesh. He had to pay close to US$100 for the tests.
People co-infected with HCV and HIV also need to monitor indicators of HIV progression, such as their CD4 count. If the CD4 count falls below 200, then HCV treatment is less effective, and its side-effects may be more pronounced. Umesh suggests that those people with HIV who are taking antiretroviral (ARV) drugs should consult their doctors to find out if they need to change their ARV combination before starting HCV treatment.
Another challenge is the limited availability of PCR tests. In India for example, the test is available in only one city (Mumbai), although blood samples are collected from other parts of the country and sent there for diagnosis. The results can take more than a month to be returned.
Over ten years after his initial diagnosis, Umesh has just completed a course of hepatitis treatment, but getting through the treatment was not without its challenges. "We clearly need more HCV diagnostic facilities," added Umesh. "Particularly in areas with high levels of injection drug use."
HCV can often be treated successfully, including among PLHIV, but the treatment is not easy to endure. Treatment for HCV uses a single drug, or a combination of two drugs, and usually takes between six and twelve months. Umesh points out that there is no standardized treatment protocol and clinical practice varies considerably between individual doctors. This can add to uncertainty and confusion for patients.
The treatment for HCV is also very expensive – costing on average approximately US$250 per week. Interferon injections are given weekly, in addition to ribavirin tablets. The tablets may be provided free for people paying for interferon injections. On purchasing four interferon injections, one extra is often provided free as a 'discount.' But in countries such as India, people have to bargain with representatives of pharmaceutical companies or doctors, remarks Umesh. A cheaper alternative is to use interferon injections alone, although this is reported to be less effective. Umesh comments that high-profile donor agencies including the Clinton Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) are yet to dedicate resources to providing treatment for HCV.
Another dispute among clinicians surrounds the diagnostic value of a liver biopsy. In well-resourced countries, a liver biopsy is usually performed to determine the extent of hepatitis-related liver damage, whereas in Asian countries such as India, China, Vietnam, and Thailand, doctors usually avoid this procedure. Consensus is needed around the diagnostic utility of liver biopsy, if nothing else in order to eliminate additional confusion for patients.
There is no vaccine to prevent HCV infection and even after successful completion of treatment, HCV reinfection can occur. During and after treatment, HCV PCR viral load testing is done at six month intervals to monitor HCV control.
Umesh says that people with HCV considering treatment should connect with those who have previously been through it. The initial days of the regime can be very frustrating and challenging, including loss-of-appetite and flu-like symptoms — it helps to talk to those who have completed the regimen before. Even after successful completion of HCV treatment, it is vital to keep the HCV viral load low. Umesh recommends that drug and alcohol use should be avoided in order to protect liver functions. Also people with HCV need to take care of their livers by avoiding spicy or fatty foods.
Umesh recalls, "I learnt from my doctor, Dr Samiran Panda, in the early 1990s, who taught me how to take care of myself and monitor my own health."
Umesh has proactively sought information over the years, in order to look after his own well-being as well as possible. As a result, he has developed a comprehensive understanding of issues around HIV, injection drug use, as well as HCV.
Developing these kinds of self-management abilities is vital: To monitor and control symptoms of hepatitis C, to minimise other complications or opportunistic infections, or hopefully to prevent their onset entirely.
For people co-infected with HCV and HIV, self-management and treatment literacy skills may be all the more crucial.
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March 13th, 2007
Score Predicts GI Bleeds from Varices in Liver Disease
www.gastrohep.com
A clinical score predicts upper GI hemorrhages from varices in chronic liver disease, finds March's issue of the Scandinavian Journal of Gastroenterology.
Upper gastrointestinal (GI) bleeding from esophageal or gastric fundus varices is a common complication of portal hypertension in liver cirrhosis.
It carries a high mortality rate of 20% to 35%.
Stratifying high-risk patients for variceal bleeding is mainly based on endoscopic scoring.
Dr Frank Tacke and colleagues from Germany developed a simple clinical score to assess the bleeding risk in patients with chronic liver disease.
22% developed upper GI hemorrhages from varices -- Scandinavian Journal of Gastroenterology
The research team identified 111 patients with chronic liver diseases for potential liver transplantation, with a follow-up of 6 years.
The team analyzed findings at study entry for their value in predicting hemorrhages.
The researchers found that 22% of patients developed upper gastrointestinal hemorrhages from varices during the follow-up period.
Common characteristics at study entry of patients with future bleedings included viral hepatitis or alcoholic etiology.
The team noted that advanced-stage cirrhosis, and decreased liver function were other characteristics at study entry.
Patients also presented with impaired hemostasis, and endoscopic presence of varices at study entry.
The research team found that these parameters were independent predictors of bleedings.
A 4-item Bleeding Risk Score was used to identify patients at high or low risk of bleedings.
The score included cholinesterase less than 2 kU/l, and an international normalized ratio higher than 1.2.
Viral or alcoholic etiology, and presence of varices was also included in the score.
The researchers found that the score was superior in sensitivity and specificity to the Child-Pugh or mucosa associated lymphoid tissue score.
Dr Tacke's team concluded, “A simple clinical score can predict the risk for upper gastrointestinal bleedings in patients with chronic liver disease.”
“This Bleeding Risk Score may help to supplement current endoscopic and clinical approaches to identify high-risk patients.”
Scand J Gastroenterol 2007: 42(3): 374-82
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HIV/Hepatitis Coinfection - Selection from: 14th Conference on Retroviruses and Opportunistic Infections (CROI 2007)
www.medscape.com
Medscape: I'm Dr. Mary Anderson of Medscape HIV/AIDS and I'm speaking with Dr. Vincent Soriano at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles. Dr. Soriano is an Assistant Professor and the Director of the Department of Infectious Diseases in the Hospital Carlos III in Madrid, Spain. Dr. Soriano has agreed to discuss the most important data from this meeting regarding HIV/hepatitis coinfection. Thank you for offering to speak with us about this important topic, Dr. Soriano.
The management of viral hepatitis in persons with HIV coinfection is often more difficult compared with people with monoinfection; for example, achieving a sustained virologic response has been more challenging in patients with hepatitis C virus (HCV) coinfection. Was any significant progress reported here?
Dr. Soriano: Yes. The most important thing here came from the presentation from Dr. Raymond Chung from Boston, and he just presented and summarized the main results from the 3 randomized clinical trials, APRICOT [AIDS PEGASYS Ribavirin International Coinfection Trial], RIBAVIC, and the ACTG [AIDS Clinical Trial Group] 5071; almost all of them showed that when using flat doses of ribavirin of 800 mg/day, the results are quite poor compared with monoinfected individuals. And he commented that what we need to address right now is whether increasing the doses of ribavirin, as has been explored in the PRESCO trial, may provide a higher rate of sustained virologic response in HIV/HCV-coinfected people.
The other point that he highlighted is that we really need to treat these patients despite all of the obstacles. An important consideration is that liver transplantation in the coinfected population will not be the solution, so we need to stop progression to end-stage liver disease. We need to improve the tolerability of antiviral drugs in treating hepatitis C, because in the end, if these patients progress, we will not have a solution. Transplantation doesn't provide a cure.
Medscape: The treatment of hepatitis B is also complicated by HIV coinfection, in part because some of the agents to treat hepatitis B virus (HBV) are also active against HIV. What developments in this area were reported at this meeting?
Dr. Soriano: On the topic of HBV and HIV coinfection, there were 2 presentations that were the focus of attention. One came from Julie Sheldon in Madrid who studied patients coinfected with HIV and HBV who were exposed to lamivudine for many, many years. HBV from almost all of those patients carried resistance mutations to lamivudine in hepatitis B. Interestingly, a significant proportion of them carry what we call double or triple mutations to lamivudine and some of them produce what we call "vaccine escape." These are mutations in the polymerase of hepatitis B that affect the antigenicity of the surface antigen and may produce changes in the structure of these proteins that may make it possible for them to "escape" from vaccine. This is important because at the same time they also may vanish or may be hidden, so that they are not detected by the diagnostic test for the surface antigen producing acute hepatitis B.
The second presentation involved some unexpected data concerning the use of entecavir in HIV/HBV-coinfected patients. Chloe Thio at the John Hopkins University saw a decline in HIV viremia in 3 patients who were taking entecavir. All of our information available until this time about the activity of entecavir was that its activity was restricted to hepatitis B. But the information from John Hopkins suggested that entecavir may also be active against HIV. In fact, in one of the patients, selection of the M184V mutation in HIV occurred after exposure to entecavir monotherapy, so the role of entecavir in coinfected patients should be examined.
Medscape: Monitoring the progression of liver disease is important in deciding when to treat, and there has been considerable interest in finding a less invasive method to replace liver biopsy. Has there been any progress?
Dr. Soriano: Yes. The topic was discussed in an elegant manner by David Thomas from John Hopkins and he really did a very nice and well-balanced presentation for defenders of liver biopsy and nondefenders of liver biopsy. The main conclusion was that in 2007, when we look at the information of fibrosis just for therapeutic purposes, we probably no longer need liver biopsy.
The new tools to assess liver fibrosis -- mainly derived from serum fibrosis markers or imaging techniques such as FibroScan elastography -- probably provide us with enough reliable information to guide therapy. Using the combination of some fibrosis markers and FibroScan, we probably have right now the best approach to quickly find the state of fibrosis. If the patient doesn't need treatment, we know that we can longitudinally follow that patient, and when the time for treatment arrives, ie, a fibrosis score of F2 or more, we can provide therapy at that time.
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Fluid In Abdominal Cavity Signals Variety of Illnesses
http://www.nj.com/
BY R. KNIGHT STEEL
STAR-LEDGER STAFF
All of us note changes in our appearance as we age. Even if not overweight, we may notice that our abdomen seems to be a little protuberant as we tend to lose muscle strength in our abdominal wall.
A number of organs, including the liver, spleen, pancreas and intestines, as well as a tiny amount of fluid, are found in the abdominal cavity. When the quantity of fluid increases significantly, it is called ascites.
On occasion, there may be so much fluid, the elder has a strikingly protuberant and even tense abdomen. This is not a normal change associated with aging.
There are many causes of ascites, but the most common is cirrhosis, chronic scarring of the liver. Large amounts of alcohol consumed over many years may be responsible. Also, the older person may have become infected with hepatitis C during a blood transfusion decades earlier.
Sometimes, a malignant tumor has seeded the peritoneal cavity, resulting in ascites. The presence of a malignancy may be recognized first when ascites develops, often over a brief period of time.
An infection may cause ascites. An elder may have had tuberculosis that went unrecognized many years previously. After having been quiescent for some time, the bacterium responsible for tuberculosis may seed the peritoneal cavity. It may be associated with other signs of an infection, such as fever.
A number of other diseases may be responsible for ascites. Inflammation of the pancreas may cause fluid to accumulate in the abdomen. Sometimes, this condition is associated with alcohol excess and liver disease, as well. Kidney failure may cause fluid to accumulate throughout the body and may first be recognized by the appearance of ascites. On rare occasions, ascites is caused by low levels of thyroid hormone.
The work-up of ascites begins with a series of questions. A history of blood transfusions or heavy alcohol consumption may point the way to the diagnosis. There may be clues on the physical examination, as well. For example, there may be signs of chronic liver disease, such as reddening of the palms of the hands and striking wasting of the facial muscles. The abdomen may be tender to touch, suggesting acute inflammation. There may be evidence of a malignancy, for example, marked weight loss in spite of an increasing abdomen.
The commonly ordered blood tests may reveal liver disease or kidney failure. If it is not clear if ascites is present, an ultrasound study may be ordered. An abdominal CT scan may reveal changes in the liver and an enlarged spleen, suggesting cirrhosis. If there is doubt as to the cause of ascites, a needle may be inserted into the peritoneal space and some of the fluid removed for study. The white blood cell count in the fluid may be elevated because of an infection and a culture may reveal the organism. A cytologic examination may reveal the presence of tumor cells.
Write to Dr. R. Knight Steel at Hackensack University Medical Center, 30 Prospect Ave., Hackensack, N.J. 07601.
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Nokia China in Lawsuit over Hepatitis B Carrier
http://news.yahoo.com
By Mure Dickie
A Chinese job applicant on Tuesday filed a lawsuit against Nokia alleging that a local unit of the Finnish telecommunications equipment company refused to employ him because he is a carrier of the Hepatitis B virus.
The highly unusual lawsuit underscores moves by Hepatitis B carriers to use legal channels to challenge what they say is endemic discrimination against the estimated 120m Chinese infected by the virus.
Chinese companies routinely refuse to employ people who carry the Hepatitis B virus, even though it is mainly transmitted at birth, through sexual contact or by contaminated needles.
However, the job applicant, who asked to be identified only by his surname, Li, said he had been surprised when the Nokia unit in China's southern city of Dongguan cancelled plans to hire him after a company-ordered medical examination.
"I thought that as a big company, Nokia would have a better understanding of this issue," Mr Li said. "But they still said that because I was a [Hepatitis B] carrier, they had to reject me."
Mr Li yesterday filed a lawsuit at a Dongguan court calling on it to order Nokia to hire him and to pay Rmb500,000 ($64,540, £33,370, EU48,830) in compensation for "mental suffering".
Nokia stressed its global policy did not allow hiring decisions to be affected by whether an applicant was suffering from a chronic disease, such as Hepatitis B, unless the condition would render the employee incapable or would pose "considerable risk" to others.
"We are looking into this case," said Thomas Jönsson, director of communications for Nokia China. "If a mistake has been committed, we will follow up and take whatever measures are required to correct it."
Mr Li's case has emerged at a time when a growing number of Chinese are taking companies and even government departments to court over issues such as discrimination. Such litigants often face laws that are ambiguous, courts that rule inconsistently and patchy enforcement of rulings.
Lu Jun, a health activist who runs a website for Hepatitis B carriers, said Mr Li's lawsuit appeared to be the first of its kind against a western company. Antidiscrimination lawsuits against local companies were also very rare and often failed, in part because of China's contradictory legislation on Hepatitis B, Mr Lu said.
Officially, discrimination against Hepatitis B victims is banned under a sweeping but vaguely worded 2004 law and the health ministry says carriers can live, work and study "normally". However, those infected with the virus are banned by official regulations from working in sectors such as the food industry and are sometimes blacklisted even by government departments.
Last year, a top school in China's northwestern Xinjiang region expelled 19 children after discovering they were infected with the virus.
A lawsuit brought by parents of the children against local education authorities was abandoned under what people familiar with the situation said was heavy pressure from officials.
Unlike the less serious but more infectious Hepatitis A virus, Hepatitis B carriers pose little risk to co-workers or fellow students.
But fear of the disease, which leaves most carriers unharmed but can cause serious liver damage and death, has been stoked in China by widespread advertising by medicine vendors.
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March 14th, 2007
Prison's Deadliest Inmate, Hepatitis C, Escaping
www.msnbc.msn.com
The Associated Press
Public-health workers warn of looming epidemic of ‘silent killer’
VACAVILLE, Calif. - The most dangerous thing coming out of prison these days may be something most convicts don’t even know they have: hepatitis C.
Nobody knows how many inmates have the disease; by some estimates, around 40 percent of the 2.2 million in jail and prison are infected, compared with just 2 percent of the general population.
Eventually, when they are released, medical experts predict they will be a crushing burden on the health care system, perhaps killing as many people as AIDS in years to come. At the same time, they will be carriers, spreading the disease.
Hepatitis C can be treated, but many prisons do not test for it. Among the reasons: Budgets are tight, and treatment is expensive. So prison officials close their eyes to the gathering emergency and pass it along to the outside world.
“Right now there’s a golden opportunity to bring solutions to this problem before it hits,” said Dr. John Ward, director of viral hepatitis at the National Center for HIV/AIDS at the Centers for Disease Control and Prevention in Atlanta.
Hepatitis C is already the most common disease of its sort in the United States — a chronic, life-threatening, blood-borne infection. It is most commonly linked to infected needles used for drugs, though prison tattoos and body piercing with non-sterile equipment are also risky.
'Silent killer'
What makes this virus particularly insidious is that as many as half of the people who have hepatitis C don’t even know they have it. The “silent killer,” already considered epidemic by the World Health Organization, often remains dormant for decades.
Some of the infected are lucky: One in five people who get hepatitis C will clear it out of their system naturally. But without treatment, one in four will suffer liver failure or develop liver cancer. Last year liver cancer was the only one of the top 10 fatal cancers in this country to increase, in large part because of hepatitis C.
More than $1 billion is already spent each year on this country on hepatitis C, and those costs are expected to soar unless prevention and treatment are expanded.
Without those changes, researchers project that liver-related deaths will triple from around 13,000 in 2000 to 39,000 by 2030. It’s also estimated that 375,000 Americans with hepatitis C will develop cirrhosis by the year 2015.
Anita Taylor, 48, is already there, in end-stage liver disease. Taylor speaks very slowly and moves with care. She often finds that she can’t say the words she wants to — they just won’t come out. Her body hurts most of the time. Her nose bleeds a lot.
'Doctor gave me a death sentence'
A mother of two and former heroin addict, Taylor said she learned she had hepatitis C when she was jailed in Nevada in 1991 for being under the influence of drugs.
“They tested me and told me I had hepatitis C. They didn’t tell me there was a treatment and a cure,” she said. “And I didn’t know to ask.”
Taylor’s experience is not unusual.
“The doctor gave me a death sentence, recalls Leslie Czirr, a 36-year-old parolee. “He told me, ’There’s no cure for this and you will die from it unless you are hit by a truck first,”’
Czirr learned she had hepatitis C during a prenatal examination in 1996, at a time when she wasn’t in prison. Czirr has been arrested 10 times for drug possession and served almost eight years in prison on various drug possession and dealing charges.
She has started to suffer exhaustion, brain fog and aches. She recently enrolled in a county program to be treated — treatment, she said, she was denied at California’s Norco State Prison.
“I asked and asked, but they barely want to give you a Motrin,” she said. “I really want to get well, not just for myself, but so I’m not putting anyone else at risk.”
Limited studies indicate that fewer than 10 percent of prisoners who have contracted hepatitis C are treated. The reason vary. Medical staff have other priorities, and not all are well-informed about the disease. Prisoners with short sentences are often excluded because they won’t be able to complete treatment, and drug addicts who are inclined to return to risky behavior are often turned away because it is assumed they will simply reinfect themselves.
No funding for treatment
Usually, though, it comes down to money. Prison officials say that even if they wanted to provide the treatment, it is extremely expensive — about $9,500 per patient per year — and no federal funds have been earmarked to pay for it.
“It’s a hard sell to convince taxpayers why additional resources should be spent on the health care of the incarcerated when there are a lot of people who aren’t incarcerated who don’t have adequate health care,” said Dr. Joseph Bick, chief medical officer at the California Medical Facility at Vacaville.
Many of the inmates in Vacaville’s hospice unit — reserved for those given six months or less to live — are dying from hepatitis C-related ailments. Bick said half of the prison’s 3,200 inmates have a history of having been infected with hepatitis C, and at any given time about 40 of those men are receiving the intensive drug treatment to cure it.
“I’m pretty sure this is how I got it,” said Anthony Harris, an inmate at Vacaville. He rubbed his forearm hard, as if trying to remove the prison tattoo bearing his children’s names.
Harris, 51, is a former barber serving a life sentence for second-degree murder. In 2003, a doctor at another prison told him he had Hepatitis C; he researched the disease in the prison library and has sought treatment ever since.
“They gave me shots for Hep A and B, got rid of them. I’d like to get rid of the C too,” he said. “I’m entitled to that. But some docs will give you the treatment and others won’t. I keep making appointments. I keep asking.”
The course of treatment can take a year, and involves taking pills twice a day and weekly injections. Side effects are like those associated with chemotherapy — nausea, exhaustion, depression, debilitating aches and pains — and the cure only works about half the time.
But Bick said the high cost of treating prisoners for hepatitis C is a bargain compared to the bill that would come due if these cases are left untreated. “It’s a tremendous opportunity for us to have an impact on the larger health of the community,” he said.
Dr. Lynn Taylor, an assistant professor of medicine at Brown University’s medical school, agrees that prison is “perhaps one of the best setting for treatment of high-risk individuals.”
'Window of opportunity' for public-health efforts
“Prison can be a window of opportunity to reduce the reservoir of infection,” she said.
But there are no federal rules about testing and treating hepatitis C. Federal guidelines, issued by the CDC in 2003, said correctional facilities should “become part of prevention and control efforts in the broader community.” But they don’t recommend screening for all inmates.
Instead, the CDC urged medical staff to ask new inmates about their risk factors, and only those prisoners who seem likely to be exposed should undergo screening, which costs $5 to $10.
The CDC guidelines fell short, said Dr. Josiah Rich, a professor at Brown who directs the university’s Center for Prisoner and Human Rights. Rich’s studies confirm that convicted criminals are almost always willing to be tested for hepatitis C, but will often lie to prison authorities about their past drug use.
“We already know that more than one in three people coming through corrections has Hep C, so by definition everyone coming in is high risk. It’s absurd that they’re not testing everyone,” he said.
Rich concedes that testing every inmate will “jack up costs” for prisons.
“An individual is going to say, ’Hey, you tested me, you said I was positive, and now I want to be treated, and I’m going to sue you if I don’t get treated,”’ he said.
Lawsuits on the rise
Lawsuits are, indeed, on the rise.
The first significant case came in 1999, when officials at the Luther Luckett Correctional Complex in La Grange, Ky., refused to allow inmate Michael Paulley access to free hepatitis C treatment. Paulley, who was serving a 25-year sentence for rape and burglary, sued and won.
But the treatment came late and he died in 2004, the year he would have been eligible for parole. The litigation prompted broader testing and treatment in Kentucky, but Paulley’s physician, Dr. Bennet Cecil, a Louisville, Ky.-based hepatitis C specialist, said prisoners still die “all the time” for untreated hepatitis C.
“I think it’s immoral if a country, a state a society is going to incarcerate somebody and then deny them necessary medical care. I think that’s an outrage,” he said.
Prisons in at least a dozen states — Alabama, California, Delaware, Florida, Georgia, Idaho, Michigan, Mississippi, Nebraska, New York, Oklahoma and Virginia — are being sued over failure to treat hepatitis C.
But it’s tough going, said Oregon civil rights attorney Michelle Burroughs. Although she’s won a settlement that mandated testing for at risk inmates and treatment for those who are eligible, five of the 10 inmates she’s representing in a class-action lawsuit have died while the litigation proceeds.
5-year wait
“It’s appalling, horrendous, horrifying. Prisoners wait five years just to be evaluated,” she said.
Rep. Barbara Lee, D-Calif., recently reintroduced legislation that would mandate prison testing and treatment of hepatitis C. Earlier similar proposals in recent years have failed.
“The plain fact is that prisoners do not stay in prison. With more than 90 percent of incarcerated persons returning to their communities, it is clear that when a prisoner is infected, we are all affected,” Lee said.
In North Dakota, it didn’t take legislation, court orders or new regulations to prompt medical services director Kathleen Bachmeier to begin screening every inmate for hepatitis C after a methamphetamine epidemic tripled her state’s prison population in about a decade. As the intravenous drug addicts arrived, so did the hepatitis C.
“It became obvious to me that these people are going to cost the state a lot of money if we don’t do something about it,” she said.
North Dakota now treats anyone who meets certain medical criteria, whose sentence is long enough to complete the course of treatment and who is willing to try to quit using drugs.
“We look at this as a huge public health initiative,” she said.
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Roche Driving PROGRESS in Treatment of Hepatitis C Patients with New PEGASYS(R) Trial
http://biz.yahoo.com
Large study examines fixed dose induction of PEGASYS in patients with difficult to treat characteristics
NUTLEY, N.J.--(BUSINESS WIRE)--Roche today announced the start of a large, multinational trial to examine a new treatment strategy in hepatitis C patients with difficult-to-treat characteristics. This study will evaluate the effect of PEGASYS® (peginterferon alfa-2a) and ribavirin in patients who have a high level of genotype 1 virus in their blood (high viral load) and who are heavier than average in weight. The trial, known as PROGRESS (PEGASYS and Ribavirin Optimized in Genotype 1 high virRal load patiEntS to improve SVR), will examine the potential benefits of using a fixed dose induction (360 mcg) of PEGASYS for the first 12 weeks of therapy.
"We have seen major advances in treatment success rates for hepatitis C in recent years," said Dr. Rajender Reddy, University of Pennsylvania and one of the lead study investigators. "However, patients with high levels of genotype 1 virus in their blood and who also are overweight tend not to respond as well to current antiviral therapy regimens. PROGRESS will reveal whether induction dosing with PEGASYS in combination with either a higher dose or a standard dose of ribavirin offers these patients an improved chance of treatment success."
About the PROGRESS Trial
More than 1,000 patients will be enrolled in PROGRESS and will be randomized to receive one of four dosing regimens of PEGASYS plus ribavirin for 48 weeks, followed by a 24-week treatment-free follow-up period. The four dosing regimens are:
- A fixed-dose induction (360 mcg) of PEGASYS given once every week for the first 12 weeks then the standard 180 mcg dose of PEGASYS for the following 36 weeks. Patients will also receive a 1,400-1,600 mg daily ribavirin dose for the full 48 week treatment period.
- A fixed-dose induction (360 mcg) of PEGASYS given once every week for the first 12 weeks then the standard 180 mcg dose of PEGASYS for the following 36 weeks. Patients will also receive the standard dose of ribavirin (1,000-1,200 mg daily) for the full 48 week treatment period.
- The standard 180 mcg dose of PEGASYS for 48 weeks plus a 1,400-1,600 mg daily ribavirin dose for the full 48 week treatment period.
- Control group who will receive the standard of care with weekly 180 mcg PEGASYS dose plus ribavirin (1,000-1,200 mg daily) for the full 48 week treatment period.
Large Multinational Clinical Trial
Fifteen countries will participate in the trial with a total of 150 trial sites. Enrollment is ongoing in the U.S., and well as Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Hungary, Norway, Poland, Romania, Russia, Sweden and the United Kingdom. The trial is expected to conclude in 2008.
"Roche recognizes that there is an urgent need to improve the chances of patients with difficult-to-treat characteristics to achieve treatment success, which is why we are launching PROGRESS," said Tom Klein, Vice President, Hepatology, Roche. "This new, landmark trial with PEGASYS underscores our long-term commitment to finding treatment solutions for as many patients as possible."
Previous studies have suggested that induction doses of PEGASYS, together with higher doses of ribavirin, may be of value in improving outcomes in patients with heavier than average bodyweight, genotype 1 hepatitis C and a high viral load. PROGRESS also will assess the critical and evolving role of ribavirin in optimizing treatment for patients with hepatitis C.
Those interested in the trial can find more information at www.roche-trials.com.
About Hepatitis C
Hepatitis C, a blood-borne infectious disease of the liver, is transmitted through body fluids, primarily blood or blood products, and by sharing needles. Hepatitis C chronically infects an estimated 2.7 million Americans and 170 million people worldwide and is the leading cause of cirrhosis and liver cancer and the number one reason for liver transplants in the U.S.
About PEGASYS
PEGASYS, in combination with COPEGUS (ribavirin), is indicated for the treatment of adults with chronic hepatitis C who have compensated liver disease and have not previously been treated with interferon alpha. Efficacy has been demonstrated in patients with compensated liver disease and histological evidence of cirrhosis (Child-Pugh class A) and patients with HIV disease that are clinically stable (e.g., antiretroviral therapy not required or receiving stable antiretroviral therapy). In addition, PEGASYS in combination with COPEGUS is the first and only FDA-approved regimen for the treatment of chronic hepatitis C in patients coinfected with hepatitis C and HIV. PEGASYS is the only pegylated interferon indicated for the treatment of adult patients with chronic hepatitis B (HBeAg positive and HbeAg negative chronic hepatitis B who have compensated liver disease and evidence of viral replication and liver inflammation).
PEGASYS is dosed at 180mcg as a subcutaneous injection taken once a week. COPEGUS is available as a 200mg tablet, and is administered orally two times a day as a split dose. Roche has backed PEGASYS with the most extensive clinical research program ever undertaken in hepatitis C, with major studies initiated to advance treatment for hepatitis C patients with unmet needs, including patients co-infected with HIV and HCV, African Americans, patients with cirrhosis, and patients who have failed to respond to previous therapy.
Important Safety Information about PEGASYS
What is PEGASYS?
PEGASYS is a medicine used to treat some adults who have hepatitis C or hepatitis B and signs of liver damage. PEGASYS works to reduce the amount of virus in your blood, helping your body fight the virus.
PEGASYS (Peginterferon alfa-2a), like other alpha interferons, can cause fatal or make life-threatening problems worse (like mental, immune system, heart, liver, lung, intestinal and infections). Your doctor should monitor you during regular visits. If you show signs or symptoms of these conditions, your doctor may stop your medication. In most patients, these conditions get better after you stop taking PEGASYS (see medication guide for more information and warnings).
What is COPEGUS?
COPEGUS is a medicine that works by slowing down the growth of the virus. COPEGUS should be taken with PEGASYS to fight the virus. Do not take COPEGUS by itself.
COPEGUS (Ribavirin, USP) can be extremely harmful and cause birth defects in an unborn baby. Female patients and the female partners of male patients should avoid getting pregnant. Ribavirin is known to cause anemia (low red blood cells), which can make heart disease worse. Also, Ribavirin can harm your DNA and possibly cause cancer (see medication guide for more information and warnings).
Who should not take PEGASYS and COPEGUS?
Do not take PEGASYS alone or with COPEGUS if:
- You are pregnant or your partner is pregnant
- You or your partner plans to get pregnant during therapy or within 6 months after treatment ends
- You are breastfeeding
- You have hepatitis caused by your immune system (autoimmune hepatitis)
- You have unstable or severe liver disease before or during treatment
- You are allergic to alpha interferons or any of the ingredients in PEGASYS and COPEGUS
- You have abnormal red blood cells (caused by conditions like sickle-cell anemia or thalassemia major)
- What if I am pregnant or thinking about having a baby?
If you are a woman who could get pregnant, you must take pregnancy tests before, during and for 6 months after treatment ends to make sure you are not pregnant.
During treatment and for 6 months after treatment, female and male patients must:
- Use two forms of birth control (one being a condom with spermicide)
- Tell your doctor right away if you or your partner becomes pregnant. You or your doctor should also call the Ribavirin Pregnancy Registry at 1-800-593-2214
What medication should I avoid when I am taking PEGASYS and COPEGUS?
You should not take didanosine with COPEGUS. Talk to your doctor about all medications that you are taking.
What are the possible side effects?
The most common side effects of PEGASYS and COPEGUS are:
- Flu-like symptoms (including fever, chills, muscle aches, joint pain, headaches)
- Tiredness
- Upset stomach (like nausea, taste changes, diarrhea)
- Blood sugar problems (may lead to diabetes)
- Skin problems (like rash, dry or itchy skin, redness and swelling at injection site)
- Hair loss (temporary)
- Trouble sleeping
The most serious side effects of PEGASYS and COPEGUS are:
- Risks to pregnancies
- Mental health problems (such as irritability, depression, anxiety, aggressiveness, trouble with drug addiction or overdose, thoughts about suicide, suicide attempts, suicide and thoughts about homicide)
- Blood problems (like a drop in blood cells leading to increased risk for infections, bleeding and/or heart or circulatory problems)
- Infections (which sometimes cause death)
- Lung problems (like trouble breathing, pneumonia)
- Eye problems (like blurred vision, loss of vision)
- Autoimmune problems (such as psoriasis, thyroid problems)
- Heart problems (including chest pain and, rarely, a heart attack)
- Liver problems (rarely, liver function worsens). Patients with both the hepatitis C virus and HIV can have an increased chance of having liver failure during PEGASYS treatment. Change in a blood test that measures liver inflammation occurs more often in patients with hepatitis B. If you have a rise in this blood test you may need to be watched more closely with additional blood tests.
Tell your doctor immediately if you think you or your partner may be pregnant or if any of these symptoms occur.
About Roche
Hoffmann-La Roche Inc. (Roche), based in Nutley, N.J., is the U.S. pharmaceuticals headquarters of the Roche Group, one of the world's leading research-oriented healthcare groups with core businesses in pharmaceuticals and diagnostics. For more than 100 years, the Roche Group has been committed to developing innovative products and services that address prevention, diagnosis and treatment of diseases, thus enhancing people's health and quality of life. An employer of choice, in 2006, Roche was named one of the Top 20 Employers (Science magazine), ranked the No. 1 Company to Sell For (Selling Power), and one of AARP's Top Companies for Older Workers, and in 2005, Roche was named one of Fortune magazine's Best Companies to Work For in America. For additional information about the U.S. pharmaceuticals business, visit our websites: http://www.rocheusa.com or www.roche.us.
Contact:
Roche
Mike Nelson, 973-562-2409 mike.nelson@roche.com
or
MS&L
Joseph St. Martin, 212-468-3731 joe.stmartin@mslpr.com
Source: Hoffmann-La Roche Inc.
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Education Another Weapon against Hepatitis' Spread
http://www.kare11.com
By Martha Mendoza, AP National Writer
"Hi everyone. I am Leslie. I had hepatitis C. I was treated. I am cured," shouts Leslie Benson, whirling a shawl around her shoulders and jumping to the front of the room.
Twenty women lounging on sofas, kneeling on the floor and sitting on the staircase in the corner perk up, turning intently to stare at Benson. Some smile a bit. This matters deeply to these women, mostly parolees, finishing up sentences in a clean and sober living home.
Benson, executive director of a nonprofit hepatitis C prevention group Education for Healthy Choices brings her message -- along with movies, plastic livers for demonstrations, prizes and handouts -- to recovering drug addicts 10 times a month.
She is frank: "If you shoot up, you probably got it," she tells them.
She's scary: "This virus is wily, tough and super-concentrated. It can live in dried blood for four days. You can find 40 million copies of the virus in one milliliter of blood."
She's also inspirational: "The liver is the only organ that regenerates itself. Which is why you want try to go after this."
Benson isn't sure whether she contracted the virus during a one-week experiment with injected drugs as a teen, or from a blood transfusion she received after a serious accident. In either case, it took 35 years before the symptoms hit her.
"But when I went down, I went down hard," she says. The chronic pain got so bad she couldn't work, couldn't even drive.
Hepatitis C is like that. Most people carry it without symptoms for decades, but when it does kick in, they can take a fast and dangerous downturn. After a year of rigorous treatment, Benson's blood tested clear of the virus.
And today she's nothing short of a whirlwind, organizing medical meetings to train doctors about the latest treatments, chatting up potential donors, networking with colleagues to get more done.
She invokes the names of actress Pamela Anderson, who told Larry King in 2002 that her doctor told her it would kill her; singer Naomi Judd, who was treated, cured and now raises money for research; Aerosmith frontman Steven Tyler, who told "Access Hollywood" in September that the infection was now "nonexistent" in his bloodstream after 11 months of treatment, including the drug interferon.
Benson said that by having high-profile carriers speak out, more people in the country will realize the scale of the problem.
"It's considered a junkie's disease, and that's a dangerous misconception," says Benson. "This is everyone's virus, and we all should be trying to stop it."
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Valeant Pharmaceuticals Initiates Taribavirin Phase 2b Clinical Study
http://www.genengnews.com
Business Wire
Valeant Pharmaceuticals (NYSE:VRX) today announced that it has begun enrolling patients in a Phase 2b clinical study for its antiviral compound, taribavirin, an oral nucleoside (guanosine) analog, for the treatment of chronic hepatitis C in conjunction with a pegylated interferon. The Phase 2b is a multi-center, randomized, parallel, open-label study in 260 treatment-naive, genotype 1 patients and will evaluate taribavirin at 20 mg/kg, 25 mg/kg, and 30 mg/kg per day in combination with pegylated interferon alfa-2b. There also will be a control group comprised of ribavirin (800/1,000/1,200/1,400 mg daily) and pegylated interferon alfa-2b.
"Our analysis of the VISER studies has convinced us that taribavirin should be dosed based on the patient's weight to achieve efficacy equal to that of ribavirin," said Timothy C. Tyson, president and chief executive officer. "We are hopeful that this Phase 2b study will provide us with sufficient information to establish the path for registration of taribavirin for the treatment of hepatitis C."
Valeant will perform analyses of the study data after all patients have reached the week 12 time point which is the primary endpoint of the study. The results at week 12 are typically predictive of a full 48-week treatment course. Based on the 12-week data, the company will decide whether to begin another Phase 3 study at a more appropriate dose than used in the VISER studies. Additionally, if the week 12 data are encouraging, the company intends to continue the current study for a full 48-week treatment course with a post-treatment follow-up at week 72. The 12-week results are expected to be available and be released by the end of the year.
"It is important to continue studying taribavirin in combination with pegylated interferon for hepatitis C naive patients," said Fred Poordad, M.D., Chief of Hepatology at the Center for Liver Disease and Transplant, Cedars-Sinai Medical Center. "The development of this antiviral compound could be of great benefit due to its potential to reduce the anemia seen with conventional peginterferon and ribavirin therapy, which can negatively impact dosing and the chance of clearing virus."
About Taribavirin
Taribavirin is an investigational compound that has not been found by the Food and Drug Administration (FDA) or any other regulatory agency to be safe or effective in the diagnosis, mitigation, treatment or cure of any disease or illness. It may not be sold or promoted in the United States unless and until FDA has approved a New Drug Application. Similar restrictions apply in other countries.
About Valeant
Valeant Pharmaceuticals International (NYSE:VRX) is a global specialty pharmaceutical company that develops, manufactures and markets a broad range of pharmaceutical products primarily in the areas of neurology, infectious disease and dermatology. More information about Valeant can be found at www.valeant.com.
FORWARD-LOOKING STATEMENTS
This press release contains forward-looking statements, including, but not limited to, statements regarding the company's Phase 2b program that are based on management's current expectations and involve risks and uncertainties, including, but not limited to, risks and uncertainties relating to the clinical development of new products, regulatory approval processes, and other risks detailed from time to time in the company's SEC filings, including its Annual Report on Form 10-K for the year ended December 31, 2005. The company cautions the reader that these factors, as well as other factors described in its SEC filings, are among the factors that could cause actual results to differ materially from the expectations described in the forward-looking statements. The company also cautions the reader that undue reliance should not be placed on any of the forward-looking statements, which speak only as of the date of this press release. The company undertakes no responsibility to update any of these forward-looking statements to reflect events or circumstances after the date of this press release or to reflect actual outcomes.
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Rockland Assemblyman Hospitalized
http://www.nyjournalnews.com
By SARAH NETTER
THE JOURNAL NEWS
Assemblyman Kenneth P. Zebrowski has been hospitalized and is being treated for hepatitis C, causing him to miss part of the legislative session, a spokesman confirmed yesterday.
Media coordinator Keith Braunfotel said Zebrowski, a New City Democrat, underwent a procedure March 2 to treat the hepatitis and was being treated for a blood clot in his leg.
Braunfotel said Zebrowski's office remained fully staffed and that the assemblyman was working while recuperating.
"We do wish he was feeling better," Braunfotel said, "but he's as sharp as a tack."
State Sen. Thomas Morahan, R-New City, is a close colleague and friend of Zebrowski's and has visited him often.
"He's laid up for a while and his legislative agenda is being attended to," Morahan said.
Little has been said about Zebrowski's illness or treatment.
"The family's kind of keeping it close to the vest, so to speak," Rockland Democratic Chairman Vincent Monte said yesterday.
Peter Wozniak of Valley Cottage said yesterday that he had heard a while ago that Zebrowski was ill, but he had listened to him on radio station WRCR just last week.
Wozniak said he thought Zebrowki's office was keeping up with the assemblyman's work for now.
"If it's only temporary, I'm sure it will be no problem," he said.
Morahan said his office had been in constant contact with Zebrowski's. If a public appearance is necessary, Morahan said, he will go and report back to Zebrowski on any feedback from residents or other politicians. "We hope to see him back up here soon," Morahan said.
Zebrowski, 61, began missing Assembly votes in late February and was listed as "EOR." That means he's excused for other reasons, specifically for something other than legislative business.
The last session for which he was present for all votes was Feb. 14. He was absent for votes Feb. 26 and March 5, 6 and 7, as well as for Monday's and yesterday's joint session between the Senate and the Assembly to elect four members of the state Board of Regents.
Zebrowski was ill last year, spending time in the hospital, and was noticeably thinner and had lost his hair, but told supporters and The Journal News during election season that he was feeling much better.
The Web site for the national Centers for Disease Control and Prevention says the hepatitis C virus affects the liver and is transferred by blood.
Zebrowski was first elected to the Assembly in 2004 after replacing now-Clarkstown Supervisor Alexander Gromack on the ballot. In November, he easily defeated Right to Life Party candidate Peter Partridge and had no Republican opposition. He served on the county Legislature for 21 years, including four years as chairman and two years as majority leader.
In the Assembly, Zebrowski serves on the Aging, Codes, Corporations, Authorities and Commissions, Governmental Employees, Judiciary, and Racing and Wagering committees.
Staff writer Cara Matthews contributed to this report.
Reach Sarah Netter at 845-578-2433 or snetter@lohud.com.
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Silent Killer, Hepatitis C
http://www.ocregister.com/
By CAROLINA RUIZ-MEJIA
The Orange County Register
Terri Eden wants to educate people on Hepatitis C after her husband lived unaware with the disease for almost two years.
YORBA LINDA – Patrick Eden would have turned 55 the day of his funeral.
Hepatitis C cut his life short last March; and it turns out he had been living with the disease for 17 years without knowing it.
His widow, Terri Eden, of Yorba Linda, is determined to educate people on this disease of the liver caused by a virus of the same name.
"I'd like to do something in his honor because he was a fighter," said Eden, 51. "I just want to focus on something positive so I ask myself, 'What would Pat want?' and that gives me the answer."
To honor Patrick's memory and to create awareness on the disease, a free event sponsored by Terri and Hepatitis C Awareness Inc., will be held from 5 to 9 p.m. Saturday at Java Joe's. There will be screenings, guess speakers and live entertainment, all open to the public.
Terri said her husband loved to help friends and co-workers without being acknowledged; he would make them anonymous gifts in their time of need. Patrick even paid for the purchase and installation of a chair lift in the home of a co-worker who had Lou Gehrig's disease, Terri added.
Patrick contracted the Hepatitis C virus at 35 during an operation to repair nerve damage caused by a car accident two years before. He was given infected blood.
For many years, doctors thought the high enzymes level in his liver were due to the medication he took for pain. Finally, a doctor in Yorba Linda diagnosed the Hepatitis C virus.
Kelly Zirbes, founder and volunteer for Hepatitis C Awareness, said symptoms don't appear until a very advanced stage.
Terri said her husband never showed any signs of the disease until the last year of his life.
She added that people need to be aware of Hepatitis C, because without symptoms, many don't know they have been infected.
Terri said she wants to continue her husband's legacy of helping others so she will organize an event every year around his birthday.
"I know the suffering because of my husband; it was terrible seeing him suffer," Terri said. "I don't want anyone else to go through this."
For more information on Hepatitis C, visit www.HepCAware.org.
Java Joe's is located at 4973 Yorba Ranch Rd., Yorba Linda.
Contact the writer: 714-704-3790 or cmejia@ocregister.com
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March 15th, 2007
U.S. Hepatitis Rates Fall to New Lows
http://www.washingtonpost.com
By Steven Reinberg
HealthDay Reporter
THURSDAY, March 15 (HealthDay News) -- U.S. rates of infection with hepatitis A, B and C viruses have fallen to historic lows, reducing the threat of liver disease, according to a new federal report.
Infection with these three most common forms of acute viral hepatitis have dropped dramatically between 1995 and 2005, the U.S. Centers for Disease Control and Prevention announced Thursday. Moreover, the rates of hepatitis A and B are now at their lowest levels since the federal government began collecting data more than 40 years ago, according to the CDC report,Surveillance for Acute Viral Hepatitis -- United States, 2005.
The rates of all three types of hepatitis have been dropping dramatically since the mid 1990s, noted the report's lead author, Annemarie Wasley, a CDC epidemiologist in the Division of Viral Hepatitis.
"Since 1995, there has been an 88 percent decline in hepatitis A and a 79 percent decline in hepatitis B. For hepatitis C, since the early 1990s, it's been a 90 percent decline," she said.
The statistics were published in this week's issue of the CDC journalMorbidity and Mortality Weekly Report.
Hepatitis A can affect anyone and can be contracted through contaminated water, food or person-to-person contact. Hepatitis B can be contracted through sexual contact and is a serious disease that attacks the liver, resulting in lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death. Hepatitis C can also lead to serious liver disease. It is spread by contact with the blood of an infected person.
"A lot of the decline in hepatitis A and B is due to the national vaccination strategy since the 1990s," Wasley said.
The greatest decline in hepatitis A was seen among children in those 17 states where vaccination of children has been recommended since 1999. For hepatitis B, the greatest decline was among children and teens age 15 and younger, likely due to a high vaccination rate in this age group, according to the report.
"We think a lot of the decline in cases of hepatitis C is the result of changing behaviors among intravenous drug users. They are one of the most important risk groups for hepatitis C," Wasley said. "In addition, we have better screening of blood for hepatitis C."
Education programs aimed at people at risk for hepatitis C are also credited with reducing the number of new cases, by promoting behaviors to reduce person-to-person transmission of the virus, Wasley said.
There is currently no vaccine for hepatitis C.
Wasley expects rates of hepatitis A and B to drop even further. "There may be upsurges over the next few years, but the general trend, we expect and hope, will continue to decline," she said.
"For hepatitis A, the CDC recommends that all children 12 months to 23 months be vaccinated," Wasley said. The vaccine is also recommended for people at risk for infection, including international travelers, men who have sex with men, injection and non-injection drug users, and children living in communities with high rates of the disease.
For hepatitis B, the CDC recommends three doses of vaccine beginning at birth. In addition, hepatitis B infection rates also dropped among adults but remain highest among those 25 to 44 and among people with risk factors, such as high-risk sexual activity and injection drug use.
As more children are vaccinated, the hope is the hepatitis B can eventually be eliminated, Wasley said.
"It's a little harder to see what's going to happen with hepatitis C," Wasley said. "Because without a vaccine we rely on education," she said. "We hope rates will continue to decline. We are making tremendous inroads in reducing the occurrence of all of these diseases, but there are challenges remaining."
More than 4.5 million Americans are currently infected with chronic hepatitis B and/or hepatitis C and at serious risk for liver cirrhosis and cancer.
One expert said that although much progress has been made there is still a lot to do, especially for people with hepatitis C.
"It is estimated that 50 percent of people with hepatitis C have not been identified," said Thelma King Thiel, chairman and CEO of Hepatitis Foundation International. "We are trying to educate people who have used intravenous drugs to get tested. It's hard to get people to assess their own risk behaviors."
Thiel believes that, since there is no vaccine for hepatitis C, it will require a concerted educational effort to reach those at risk.
"The progress has been great in hepatitis A and good in hepatitis B, but there needs to be more education to be sure that all children are vaccinated and reach people who have not been vaccinated," Thiel said. "It's even harder to reach people to educate them about hepatitis C," she added.
More information
For more information on hepatitis, visit the U.S. Centers for Disease Control and Prevention.
SOURCES: Annemarie Wasley, Sc.D., epidemiologist, Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, Atlanta; Thelma King Thiel, chairman and CEO, Hepatitis Foundation International, Silver Spring, Md.; March 16, 2007, CDCMorbidity and Mortality Weekly Report,Surveillance for Acute Viral Hepatitis--United States, 2005
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Non-invasive Functional MRI Focal Liver Disease Detection and Characterisation: Presented at ECR
http://www.docguide.com
By Lynda Jackson
VIENNA, AUSTRIA -- March 15, 2007 -- There is a need for noninvasive alternatives to biopsy for detection and characterisation of focal liver disease, but staging of diffuse liver disease can be done using functional magnetic resonance imaging (MRI).
"The reference examination for diffuse liver disease is biopsy, which has limitations -- it is invasive and there is substantial variability in the liver," explained Bernard van Beers, radiologist, Université Catholique de Louvain, Brussels, Belgium, during a presentation here on March 13th at the European Society of Radiology's 2nd European Congress of Radiology (ECR).
For example, biopsy specimens that are taken from different regions can be classified as being at different stages of disease. In addition, different pathologists often interpret biopsy samples differently, Dr. van Beers said.
"So there really is a need for a non invasive alternative to biopsies and functional MRI can be used to stage diffuse liver disease," Dr. van Beers said.
The most frequent diffuse liver diseases are steatosis and fibrosis, which are reversible and should therefore be detected and staged as they can have important clinical implications. "For example, liver steatosis can determine insulin resistance and progressive liver fibrosis leads to cirrhosis, portal hypertension and hepatocellular dysfunction, Dr. van Beers said. And fat infiltration in the liver can be quantified with spectroscopy, fat-selective imaging and phase contrast imaging.
According to Dr. Van Beers, multiple methods -- such as perfusion MRI, diffusion MRI, blood-oxygen-level-dependent (BOLD), spectroscopy, and magnetic resonance elastography can be combined with anatomic MRI to improve the noninvasive assessment of diffuse and focal diseases in the abdomen.
"Strictly speaking, of course, not all these MRI methods are functional. But all these MRI methods are quantitative and this is important," Dr Van Beers said.
"Staging of liver fibrosis is important because fibrosis is reversible; it can be treated especially if treated before cirrhosis occurs. Another point is hepatitis C, which is the leading cause of fibrosis in Western countries," he said. "So it is important that we detect fibrosis in its early stages and we are able to differentiate between the early stages".
"Morphological MRI can detect advanced fibrosis, but it cannot detect the early stages. So how to address this problem?" he asked. "There are important changes in the liver when fibrosis occurs, such as deposition of collagen in the extravascular space. This has two main consequences, the emergence of portal hypertension and hepatic dysfunction. Causes of these microcirculatory changes can be shown with diffusion MRI and these changes are relative to disease and markers of hepatic dysfunction. There is also a correlation between the diffusion parameters and the portal pressure, which again can be used as markers. We also found that macromolecular weight contrast agents better demonstrated fibrosis in the liver and therefore perfusion analysis performed with macromolecular contrast agents is a surrogate marker for liver fibrosis", Dr Van Beers explained.
These imaging biomarkers have the potential to give information that obviates the need for invasive procedures such as biopsy, he added.
[Presentation title: Functional Imaging. Abstract A-437]
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March 16th, 2007
Hepatitis C Remains Most Common Chronic Systemic Viral Infection in United States: Caring Ambassadors Program Urges Caution in Interpretation of CDC Report
http://www.sys-con.com
OREGON CITY, OR -- (MARKET WIRE) -- 03/16/07 -- The Hepatitis C Caring Ambassadors Program issued a statement today urging policy-makers and private citizens not to be lulled into complacency regarding the ongoing hepatitis C crisis in the U.S. The nonprofit advocacy group's statement was a reaction to the report, "Surveillance for Acute Viral Hepatitis - United States, 2005," published today by the Centers for Disease Control and Prevention (CDC) in the "Morbidity and Mortality Weekly Report (MMWR)."
"Hepatitis C is the most common, chronic, systemic viral infection in the United States -- by a wide margin," noted Dr. Tina St. John, Medical Director of the Caring Ambassadors Program. "The MMWR article addresses the incidence of acute hepatitis only, which is rarely seen with the hepatitis C virus. The vast majority of people infected with the hepatitis C virus become chronically infected and many sustain serious, even life-threatening liver damage before the infection is diagnosed. The burden of chronic hepatitis C among Americans, which is not addressed in today's MMWR article, remains alarmingly high. It is critically important that people recognize chronic hepatitis C is an ongoing, substantial problem for millions of Americans."
At least 1 in 50 Americans has already been infected with the hepatitis C virus, and CDC's report indicates that at least 20,000 new infections occur annually. "With 4 to 5 million citizens already carrying the hepatitis C virus, and 50% to 75% of them being unaware that they've been infected, we clearly have an ongoing public health crisis on our hands," noted Hepatitis C Caring Ambassadors Program Director, Lorren Sandt. She added, "We are concerned that today's MMWR article could easily be misunderstood. Most people are unfamiliar with the differences in the various forms of viral hepatitis. A mistaken sense of reassurance or complacency at this point in the hepatitis C crisis could prove devastating to control and prevention efforts. More -- not less -- attention and effort are needed to avert thousands of needless deaths due to hepatitis C," concluded Sandt.
About Hepatitis C
The hepatitis C virus (HCV) is transmitted by blood-to-blood contact. Hepatitis C is currently the leading cause of chronic liver disease in the U.S. and the most common indication for adult liver transplantation. HCV is known cause of liver cancer, the incidence of which more than doubled between 1975 and 1998, and is expected to double again by 2020. Chronic hepatitis C is associated with increased risk for other medical conditions outside the liver including diabetes, kidney disease, lymphoma, and neuropsychological maladies.
About the Hepatitis C Caring Ambassadors Program
The Hepatitis C Caring Ambassadors Program is a division of the national nonprofit public charity, the Caring Ambassadors Program, Inc. (CAP). Hepatitis C CAP is committed to improving the health and longevity of those living with chronic hepatitis C through information, awareness, and advocacy.
CONTACT:
Lorren Sandt
503.632.9032
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