Surviving Hepatitis C in AZ Jails, State Prisons, and Federal Detention Centers.

Surviving Hepatitis C in AZ Jails, State Prisons, and Federal Detention Centers.
The "Hard Time" blogspot is a volunteer-run site for the political organization of people with Hepatitis C behind and beyond prison walls, their loved ones, and whomever cares to join us. We are neither legal nor medical professionals. Some of us may organize for support, but this site is primarily dedicated to education and activism; we are fighting for prevention, detection, treatment, and a cure for Hepatitis C, particularly down in the trenches where most people are dying - in prison or on the street... Join us.

---------------------------------------------------------------

Thursday, November 18, 2010

HCV Best Practices: Early Treatment Saves Lives

Early Treatment Improves Outcomes in Acute Hepatitis C Virus Infection: A Meta-analysis

(Abstract and Intro as posted on Medscape)

K. E. Corey; J. Mendez-Navarro; E. C. Gorospe; H. Zheng; R. T. Chung

Journal of Viral Hepatitis; 2010;17(3):201-207. 


Abstract

Acute hepatitis C virus infection is associated with high rates of spontaneous clearance and variable rates of treatment-induced clearance. The benefit of early treatment versus awaiting spontaneous clearance is unknown, as is the optimal timing of treatment.We performed a MEDLINE and EMBASE search for the time period 1950 to October 2008. All English language abstracts using the search terms acute hepatitis C, hepatitis C and acute and hepatitis C and acute disease or acute infection were reviewed. Bibliographies were reviewed. Twenty-two studies including 1075 patients met the inclusion criteria. The sustained virologic response (SVR) rate for treated patients was 78%, significantly higher than 55.1% in untreated patients (OR = 3.08, 95% CI: 1.8–4.8 P value <0.0001). Mean time from diagnosis to spontaneous clearance was 9.7 weeks (SD 6.5).

SVR rates varied inversely with time from acute HCV diagnosis. SVR rates for treatment within 12 weeks was 82.5% (95% CI: 75.6–89.3), significantly better than the clearance rates in untreated patients (P < 0.001). Response rates fell to 66.9% for treatment between 12 and 24 weeks, and decreased further to 62.5% for treatment beyond 24 weeks. Rates of viral clearance in treated patients with acute hepatitis C virus infection were significantly higher than that in untreated patients. Treatment rates were highest when treatment was initiated within 12 weeks of diagnosis.  

Based on these findings, we would advocate a 12 week period of observation for spontaneous clearance before treatment initiation. If no clearance has occurred by 12 weeks, treatment should be initiated.

Introduction

Chronic hepatitis C virus infection infects more than 170 million people worldwide and more than 4 million Americans.[1] The incidence of new hepatitis C virus infections in the United States is estimated to be 100–200 cases per 100,000 people each year, with 28,000 new cases globally.[2] Unfortunately, 75–80% of patients who acquire hepatitis C virus are asymptomatic, delaying diagnosis and preventing early treatment.[3]

However, symptomatic patients who present with acute hepatitis C virus may have higher rates of spontaneous clearance, with some studies noting spontaneous clearance rates as high as 66%.[4–7] Treatment studies of patients with symptomatic acute HCV have yielded varying rates of treatment-induced SVR from as low as 21% to as high as 98%.[8–10] Trials have been limited by small patient numbers, the lack of randomized controls, and variability in enrollment criteria, including the definition of acute hepatitis C virus infection and of sustained virologic response.[11,12] Additionally, in several of these studies, early treatment (12–35 days after diagnosis) was initiated.[13,14] Early initiation of treatment most likely includes a proportion of patients who would have spontaneously cleared HCV which may overestimate the treatment response.

Recommendations for the timing of treatment initiation vary widely from 35 days after diagnosis to 120 days, with some studies suggesting that earlier treatment is associated with higher rates of SVR.[8,14–18] With high rates of spontaneous clearance and varying rates of treatment-induced clearance in symptomatic patients with acute hepatitis C virus infection, it is unknown whether treatment in the acute phase is clearly superior to watchful waiting. Furthermore, if treatment is chosen, the optimal timing of initial therapy remains unknown. Premature initiation of treatment in the acute phase may subject patients who would otherwise spontaneously clear HCV to unnecessary and costly treatment. However, delay in treatment initiation may lower rates of treatment-induced clearance.

This meta-analysis sought to more definitively establish the rate of spontaneous and treatment- induced clearance in patients with acute hepatitis C virus infection, and further sought to evaluate whether treatment outcomes vary based on the timing of treatment initiation...

References

  1. Alter MJ, Kruszon-Moran D, Nainan OV et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999; 341(8): 556–562.
  2. Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000; 31(3): 777–782.
  3. Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med 2000; 132(4): 296–305.
  4. Kamal SM, Fouly AE, Kamel RR et al. Peginterferon alfa-2b therapy in acute hepatitis C: impact of onset of therapy on sustained virologic response. Gastroenterology 2006; 130(3): 632–638.
  5. Corey KE, Ross AS, Wurcel A et al. Outcomes and treatment of acute hepatitis C virus infection in a United States population. Clin Gastroenterol Hepatol 2006; 4(10): 1278–1282.
  6. Larghi A, Zuin M, Crosignani A et al. Outcome of an outbreak of acute hepatitis C among healthy volunteers participating in pharmacokinetics studies. Hepatology 2002; 36 (4 Pt 1): 993–1000.
  7. Pekova LM, Teocharov P, Sakarev A. Clinical course and outcome of a nosocomial outbreak of hepatitis C in a urology ward. J Hosp Infect 2007; 67(1): 86–91.
  8. Jaeckel E, Cornberg M, Wedemeyer H et al. Treatment of acute hepatitis C with interferon alfa-2b. N Engl J Med 2001; 345(20): 1452–1457.
  9. Hwang SJ, Lee SD, Chan CY, Lu RH, Lo KJ. A randomized controlled trial of recombinant interferon alpha-2b in the treatment of Chinese patients with acute post-transfusion hepatitis C. J Hepatol 1994; 21(5): 831–836.
  10. Hwang SJ, Lee SD, Lu RH et al. Hepatitis C viral genotype influences the clinical outcome of patients with acute posttransfusion hepatitis C. J Med Virol 2001; 65(3): 505–509.
  11. Omata M, Yokosuka O, Takano S et al. Resolution of acute hepatitis C after therapy with natural beta interferon. Lancet 1991; 338(8772): 914–915.
  12. Griveas I, Germanidis G, Visvardis G et al. Acute hepatitis C in patients receiving hemodialysis. Ren Fail 2007; 29(6): 731–736.
  13. De Rosa FG, Bargiacchi O, Audagnotto S et al. Twelve-week treatment of acute hepatitis C virus with pegylated interferon- alpha -2b in injection drug users. Clin Infect Dis 2007; 45(5): 583–588.
  14. Hofer H, Watkins-Riedel T, Janata O et al. Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load. Hepatology 2003; 37(1): 60–64.
  15. Kamal SM, Moustafa KN, Chen J et al. Duration of peginterferon therapy in acute hepatitis C: a randomized trial. Hepatology 2006; 43(5): 923–931.
  16. Chung RT. Acute hepatitis C virus infection. Clin Infect Dis 2005; 41 (Suppl 1): S14–S17.
  17. Wiegand J, Deterding K, Cornberg M, Wedemeyer H. Treatment of acute hepatitis C: the success of monotherapy with (pegylated) interferon alpha. J Antimicrob Chemother 2008; 62(5): 860–865.
  18. Delwaide J, Bourgeois N, Gerard C et al. Treatment of acute hepatitis C with interferon alpha-2b: early initiation of treatment is the most effective predictive factor of sustained viral response. Aliment Pharmacol Ther 2004; 20(1): 15–22.
  19. Gerlach JT, Diepolder HM, Zachoval R et al. Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology 2003; 125(1): 80–88.
  20. Santantonio T, Fasano M, Sinisi E et al. Efficacy of a 24-week course of PEG-interferon alpha-2b monotherapy in patients with acute hepatitis C after failure of spontaneous clearance. J Hepatol 2005; 42(3): 329–333.
  21. Santantonio T, Sinisi E, Guastadisegni A et al. Natural course of acute hepatitis C: a long-term prospective study. Dig Liver Dis 2003; 35(2): 104–113.
  22. Kamal SM, Ismail A, Graham CS et al. Pegylated interferon alpha therapy in acute hepatitis C: relation to hepatitis C virus-specific T cell response kinetics. Hepatology 2004; 39(6): 1721–1731.
  23. Nomura H, Sou S, Tanimoto H et al. Short-term interferon-alfa therapy for acute hepatitis C: a randomized controlled trial. Hepatology 2004; 39(5): 1213–1219.
  24. Broers B, Helbling B, Francois A et al. Barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C. J Hepatol 2005; 42(3): 323–328.
  25. Calleri G, Cariti G, Gaiottino F et al. A short course of pegylated interferon-alpha in acute HCV hepatitis. J Viral Hepat 2007; 14(2): 116–121.
  26. Wiegand J, Buggisch P, Boecher W et al. Early monotherapy with pegylated interferon alpha-2b for acute hepatitis C infection: the HEP-NET acute-HCV-II study. Hepatology 2006; 43(2): 250–256.
  27. Guobuzaite A, Chokshi S, Balciuniene L et al. Viral clearance or persistence after acute hepatitis C infection: interim results from a prospective study. Medicina (Kaunas) 2008; 44(7): 510–520.
  28. Wang CC, Krantz E, Klarquist J et al. Acute hepatitis C in a contemporary US cohort: modes of acquisition and factors influencing viral clearance. J Infect Dis 2007; 196(10): 1474–1482.
Posted by at
Labels: , ,

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)