Study Shows Treating Prisoners with Hepatitis C is Cost Effective

Chronic hepatitis C is common in U.S. prisons, with prevalence estimates ranging from about 10% to about 30%. A significant proportion of the HCV-infected population passes through the correctional system each year, providing a prime opportunity for diagnosis and treatment.

Read more:

Nitazoxanide Enhances Anti-HCV Activity of Pegylated interferon/ribavirin and STAT-C Agents

Studies presented at the recent 59th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2008) in San Francisco looked at adding nitazoxanide (Alinia) to pegylated interferon and to novel directly-targeted "STAT-C" agents in the development pipeline.

Read more:

ICAAC 2008: Blood Lipid Levels and Insulin Resistance Predict Response to Interferon-based Therapy in HIV-HCV Coinfected Patients

Response to interferon-based therapy for chronic hepatitis C virus (HCV) infection varies widely across individuals, but tends to be poorer in people with HIV-HCV coinfection. Some factors associated with better response are well established -- including having HCV genotypes 2 or 3 (rather than 1 or 4) and a low baseline HCV viral load -- but others have been less extensively studied.

As reported at the 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2008) in late October, Paola Nasta and colleagues analyzed the association between baseline metabolic parameters and response rates in 96 HIV-HCV coinfected individuals undergoing hepatitis C treatment with pegylated interferon plus ribavirin.

Most (83%) were men, the median age was 43 years, 54% had HCV genotypes 1 or 4, 58% had advanced liver fibrosis (Metavir stage F3-F4), and 29% had cirrhosis. Nearly 90% were on HAART, three-quarters of them using a protease- inhibitor (PI)-based regimen.

The investigators assessed rapid virological response (RVR; undetectable HCV RNA at week 4 of treatment), early virological response (EVR) at week 12, and sustained virological response (SVR; continued undetectable HCV 24 weeks after completing therapy).

Fasting total cholesterol, LDL ("bad") and HDL ("good") cholesterol, and triglycerides levels were measured in all patients at baseline. To assess insulin resistance, the researchers determined HOMA-IR scores.

Results

• 62% achieved EVR (39% and 91% for the respective genotype groups);

• In a multivariate analysis, genotype was a predictor for RVR, EVR, and SVR.

• LDL level was only a significant factor for RVR.

• Baseline HCV RNA < 400,000 IU/mL was an additional predictor for SVR.

"Metabolic parameters are key factors to predict RVR, EVR, and SVR in HIV-HCV coinfected subjects treated with [pegylated interferon/ribavirin]," the researchers concluded.

They added that their analysis "suggest[s] a direct role" for hypertriglyceridemia (elevated triglycerides), and a possible impact of HAART-related metabolic impairment on response to hepatitis C treatment.

Inst. of Infectious and Tropical Diseases, Univ. of Brescia, Brescia, Italy.

12/9/08

Reference

P Nasta, G Gatti, G Cologni, and others. Triglycerides, LDL Cholesterol and HOMA Score Predict the Virological Response in HIV/HCV Co-infected Patients Treated with PegInterferon alfa2a/Ribavirin (PegIFN/RBV). 48th International Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2008). Washington, DC. October 25-28, 2008. Abstract H-2318.

AASLD 2008: Canadian POWeR Study Finds Patients with Advanced Liver Disease Respond Poorly to Pegylated Interferon plus Ribavirin

It is well established that chronic hepatitis C patients with advanced liver fibrosis or cirrhosis respond poorly to interferon-based therapy, but this group has the most urgent need for effective treatment. The Canadian POWeR program evaluated the impact of advanced fibrosis or cirrhosis on sustained virological response (SVR) rates in treatment-naive genotype 1 chronic hepatitis C patients treated with pegylated interferon plus ribavirin in "real-life" clinical settings between 2000 and 2007. Results were reported at the recent 59th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2008) in San Francisco.

Read more: