Thursday, September 22, 2022

Treatment Of Hepatitis C Virus Infection

Ifn Monotherapy In Acute Hepatitis C

Universal Hepatitis C Treatment

Although the short courses of standard IFN monotherapy introduced in the 1980s by Hoofnagle et al, Davis et al, and Di Bisceglie et al led to sustained improvement in liver disease and loss of virus in less than 10% of patients, these therapies were the first to cure chronic viral hepatitis.

Jaeckel et al reported that treatment with IFN alfa-2b prevented chronic infection in 98% of a group of 44 German patients with acute hepatitis C. In this study, patients received 5 million U/day of IFN alfa-2b subcutaneously for 4 weeks and then three times per week for another 20 weeks the IFN alfa-2b was well tolerated in all patients but one.

Because it has the poorest safety profile of all the HCV antiviral agents, with few exceptions PEG-IFN is no longer recommended in combination regimens. Spontaneous resolution of acute HCV infection may occur in 15% to 50% of patients. Monitoring for spontaneous clearance for a minimum of 6 months before initiating any treatment is therefore recommended.

References
  • World Health Organization. Hepatitis C: fact sheet. Available at . Updated: October 2017 Accessed: January 23, 2018.

  • Frank C, Mohamed MK, Strickland GT, et al. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet. 2000 Mar 11. 355:887-91. .

  • Kim A. Hepatitis C virus. Ann Intern Med. 2016 Sep 6. 165 :ITC33-ITC48. .

  • Pulmonary Injury Due To Interferon Therapy In Hcv Infection

    Pulmonary dysfunction due to IFN therapy in HCV-infected individuals has been reported. Garib et al. reported dyspnea after PEG-IFN therapy in HCV patients with advanced liver disease. Spirometric changes in FEV1 and FEV1/FVC were also observed. Kumar et al. introduced 4 patients who developed significant pulmonary signs and symptoms while they were on therapy with IFN-alpha and Ribavirin for chronic HCV final diagnosis was bronchiolitis obliterans organizing pneumonia in 2 patients, and interstitial pneumonitis in 2 others. In all patients, pulmonary symptoms resolved after cessation of the drug.

    How Is Hepatitis C Transmitted

    Because HCV is primarily spread through contact with infected blood, people who inject drugs are at increased risk for HCV infection. HCV can also be transmitted from an infected mother to child at the time of birth, from unregulated tattoos or body piercings, and from sharing personal items that may be contaminated with infected blood, even in amounts too small to see. Much less often, HCV transmission occurs through sexual contact with an HCV-infected partner, especially among people with multiple sex partners and men who have sex with men. Currently in the United States, health care related transmission of HCV is rare, but people can become infected from accidental needle sticks and from breaches in infection control practices in health care facilities.

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    How Effective Is Treatment

    Direct-acting antivirals cure 9 out of 10 patients with hepatitis C.

    Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.

    There’s no vaccine for hepatitis C.

    If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.

    Your doctor or nurse will be able to advise you.

    Causes And Risk Factors

    Treatment Of Hepatitis C Virus Infection Medical Concept ...

    HCV causes hepatitis C. People contract the virus through blood-to-blood contact with contaminated blood. For transmission to occur, blood containing HCV must enter the body of a person without HCV.

    A speck of blood, invisible to the naked eye, can carry hundreds of hepatitis C virus particles, and the virus is not easy to kill.

    The report the following risk factors for developing hepatitis C:

    • using or having used injectable drugs, which is currently the most common route in the U.S.
    • receiving transfusions or organ transplants before 1992, which is before blood screening became available
    • having exposure to a needle stick, which is most common in people who work in healthcare
    • being born to a mother who has hepatitis C

    The CDC offer advice on cleaning syringes if it is not possible to use clean and sterile ones. Although bleach can kill the HCV in syringes, it may not have the same effect on other equipment. Boiling, burning and using alcohol, peroxide, or other common cleaning fluids to wash equipment can reduce the amount of HCV but might not stop a person from contracting the infection.

    It is extremely dangerous to inject bleach, disinfectant, or other cleaning products, so people should make sure they rinse the syringe thoroughly. A person should only ever use bleach to clean equipment if new, sterile syringes and equipment are not available.

    People who are at risk due to these factors can have screening to rule out HCV.

    • peginterferon alfa-2a
    • sofosbuvir

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    Hepatitis C Antibody Test

    Certain foreign substances that enter your body trigger your immune system to make antibodies. Antibodies are specifically programmed to only target the foreign substance they were made to fight.

    If youve ever had a hepatitis C infection, your body will make hepatitis C antibodies as part of its immune response.

    Your body only makes these antibodies if you have hepatitis C or had it in the past. So the hepatitis C antibody test can confirm whether you have the virus by testing for these specific antibodies.

    It may take 2 to 3 months after exposure for the test to detect antibodies. If needed, your healthcare professional may order an HCV RNA test, which can detect the virus after just 1 or 2 weeks.

    If the antibody test is positive, an HCV RNA test can show whether the infection is current.

    While people of any gender experience the same hepatitis C symptoms, 2014 research suggested some effects of the virus may differ, depending on the sex you were assigned at birth.

    Researchers noted that:

    • women have a higher chance of clearing the virus without treatment
    • liver disease may progress more rapidly in men
    • men have a higher chance of developing cirrhosis

    Pericarditis And Myocarditis After Interferon Therapy In Hcv

    Teragawa et al. reported a case of pericarditis that developed in an HCV-infected individual on IFN therapy. Since then, several other studies have reported similar cases., Boonen et al. reported a 24-year-old woman that underwent IFN-alpha therapy for HCV infection and subsequently developed pericarditis later tests showed that she all criteria necessary for the diagnosis of systemic lupus erythematosus . The authors concluded that IFN-alpha therapy could result in the provocation of autoimmunity and they supported their hypothesis by citing several reports of other autoimmune disorders which occurred after IFN therapy in HCV-infected patients . Another case-report study reported similar adverse effects for PEG-IFN-2a in a 67-year-old male, in whom discontinuation of the drug plus Prednisolone therapy cured pericardial effusion within 16 days. An immune reaction might partially explain the rationale behind the pericardial effusion and pericarditis that developed after IFN therapy in HCV-infected patients. In these cases corticosteroid therapy has been highly recommended.

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    Treatment Of Hepatitis C In Patients With Liver Cirrhosis

    Mortality from hepatitis C is mainly due to manifest cirrhosis. Liver biopsy studies indicate that hepatic fibrosis may regress under therapy with PEG-IFN and ribavirin. The recommendation today is to treat patients with compensated cirrhosis with the standard combination therapy. While patients with Child-Pugh A and B cirrhosis respond and tolerate this therapy relatively well, it is unclear whether a drug reduction in Child C cirrhosis should be recommended. In general, antiviral therapy in decompensated liver cirrhosis is not recommended.

    There is data indicating that reduction of body weight in obese patients is associated with reduction in hepatic fat and in some cases of fibrosis, resulting in a better response to antiviral treatment.

    A study carried out on a Japanese population demonstrated the prevention of hepatocellular carcinoma in individuals receiving antiviral therapy. The same effect may be found in Caucasians. Successful antiviral therapy also reduces the rate of hepatic decompensation.

    Overall, even if liver transplantation in end-stage disease is not prevented by antiviral therapy, the data suggest that recurrence of disease after transplantation is significantly lowered if treated previously.

    How Many People Have Hepatitis C

    Hepatitis C Treatment Update

    During 2013-2016 it was estimated that about two and half million people were chronically infected with HCV in the United States. The actual number may be as low as 2.0 million or as high as 2.8 million.Globally, hepatitis C is a common blood-borne infection with an estimated 71 million people chronically infected according to the World Health Organization .

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    Analysis Of The Specificity Of Antigenic Recognition Of Purified Monoclonal Igs

    The INNO-LIA HCV Score was used to analyze the reactivity of patient monoclonal IgG to HCV proteins. For monoclonal IgA, dot blotting assays with HCV proteins were performed on nitrocellulose membranes spotted with 1 g of recombinant HCV core, NS3 and NS4 proteins , which were then incubated with the patients serum or with the purified monoclonal IgA. The chemiluminescent microparticle immunoassay, Alinity i Anti-HCV , on the Alinity i System was used for the qualitative detection of HCV in the patient diagnosed with Bence-Jones MM.

    The multiplex infectious antigen microarray assay was used to analyze the reactivity of serum Igs and of purified monoclonal IgG or IgA against commercially available antigens and/or lysates from EBV, cytomegalovirus , herpes simplex virus-1 , herpes simplex virus-2 , varicella-zoster virus , Helicobacter pylori , Toxoplasma gondii, and Borrelia burgdorferi, as described .

    Interferons And Pegylated Interferons

    The two most frequently used recombinant interferon preparations in clinical trials have been IFN alfa-2b and IFN alfa-2a , which differ from each other by only a single amino acid residue. IFN alfacon-1 , or consensus IFN, is a genetically engineered compound synthesized by combining the most common amino acid sequences from all 12 naturally occurring IFNs. Roferon-A was discontinued from the market in 2007 and Infergen was discontinued from the market in 2013.

    The addition of propylene glycol molecules to IFN has led to the development of long-lasting IFNs that have better sustained absorption, a slower rate of clearance, and a longer half-life than unmodified IFN, which permits more convenient once-weekly dosing. The FDA has approved PEG-IFNs for the treatment of chronic hepatitis C.

    Two PEG-IFN preparations are available for the treatment of chronic hepatitis C. PEG-IFN alfa-2b consists of IFN alfa-2b attached to a single 12-kd PEG chain it is excreted by the kidneys. PEG-IFN alfa-2a consists of IFN alfa-2a attached to a 40-kd branched PEG molecule it is metabolized predominantly by the liver.

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    Can Hepatitis C Be Prevented

    There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by:

    • Not sharing drug needles or other drug materials
    • Wearing gloves if you have to touch another person’s blood or open sores
    • Making sure your tattoo artist or body piercer uses sterile tools and unopened ink
    • Not sharing personal items such toothbrushes, razors, or nail clippers
    • Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

    NIH: National Institute of Diabetes and Digestive and Kidney Diseases

    Getting Tested Is The Only Way To Know If You Have Hepatitis C

    Hepatitis C Treatment

    A blood test called a hepatitis C antibody test can tell if you have been infected with the hepatitis C viruseither recently or in the past. If you have a positive antibody test, another blood test is needed to tell if you are still infected or if you were infected in the past and cleared the virus on your own.

    • Are 18 years of age and older
    • Are pregnant
    • Currently inject drugs
    • Have ever injected drugs, even if it was just once or many years ago
    • Have HIV
    • Have abnormal liver tests or liver disease
    • Are on hemodialysis

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    Other Systemic Complications Induced By Interferon Therapy

    Wang et al. reported a case of acute heart allograft failure induced by PEG-IFN-alpha-2b therapy due to HCV infection in a 50-year-old male which proved fatal. Postmortem autopsy showed no evidence of cellular or humoral rejection, which confirmed that the case was a fatal cardiotoxicity adverse effect due to Peg-IFN-alpha-2b.

    Myopathy and acute myositis have also been reported as adverse effects of PEG-IFN-alpha-2b therapy in HCV-infected patients. This may contribute, in part, to the cardiovascular disorders that are seen in these patients. Venezia et al. have reported a case of acute myositis after PEG-IFN-alpha-2b therapy for an HCV infection and suggested that a rapid discontinuation of IFN could resolve the problem in such cases. Golstein et al. reported a reversible case of myopathy that developed as a side effect of the same agent, which improved after drug cessation.

    Absence Of Disease Progression In Patients With Hcv

    Six patients had a monoclonal Ig that specifically recognized the HCV virus: patients P14, P7 and P8. Four of the patients received HCV antiviral treatment . As expected, after antiviral treatment, HCV loads decreased, to undetectable levels for patients P1, P3 and P4 . For patient P1, who suffered from MM in third relapse at the time of anti-HCV treatment, eradication of HCV was associated with complete remission of MM in the absence of new anti-MM therapy. The patients monoclonal IgG drastically decreased and bone marrow aspirates showed < 5% of plasma cells by cytology and minimal residual disease negativity . The number of plasma cell clones present in the sample and the tumor load was analyzed by next-generation sequencing, as previously reported . The monoclonal IgG present in pre-HCV treatment samples disappeared after anti-HCV treatment . Forty-five months later, the patient remains in CR of MM with minimal residual disease negativity as assessed by next generation flow cytometry and undetectable monoclonal IgG. Patient P1s purified monoclonal Ig specifically targeted the core protein of HCV .

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    How Is Hepatitis C Spread

    Hepatitis C spreads through contact with the blood of someone who has HCV. This contact may be through:

    • Sharing drug needles or other drug materials with someone who has HCV. In the United States, this is the most common way that people get hepatitis C.
    • Getting an accidental stick with a needle that was used on someone who has HCV. This can happen in health care settings.
    • Being tattooed or pierced with tools or inks that were not sterilized after being used on someone who has HCV
    • Having contact with the blood or open sores of someone who has HCV
    • Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
    • Being born to a mother with HCV
    • Having unprotected sex with someone who has HCV

    Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. Since then, there has been routine testing of the U.S. blood supply for HCV. It is now very rare for someone to get HCV this way.

    Management Of Sex Partners

    Heptitis C Treatments | WebMD

    Because incident HCV has not been demonstrated to occur among heterosexual couples followed over time , condom use might not be necessary in such circumstances. Persons with HCV infection with one long-term, steady sex partner do not need to change their sexual practices. However, they should discuss the risk for transmission with their partner and discuss the need for testing . Heterosexual persons and MSM with HCV infection and more than one partner, especially those with concurrent HIV infection, should protect their partners against HCV and HIV acquisition by using external latex condoms and HIV PrEP. Partners of persons with HCV and HIV should be tested for both infections.

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    Who Is At Risk For Hepatitis C

    You are more likely to get hepatitis C if you:

    • Have injected drugs

    If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.

    Medications For Hepatitis C

    Many different medications can treat hepatitis C. Treatments most often include antivirals, with Riboviria sometimes prescribed if previous treatments were ineffective.

    Medications called direct-acting antivirals work to fully remove the hepatitis C virus from your body while helping prevent liver damage at the same time.

    A few brand names of these medications include:

    • Zepatier

    6 different genotypes , or strains, of hepatitis C.

    Once your doctor or other healthcare professional knows your genotype, theyll have a better idea of which medication will work best for you. Some strains have developed a resistance to some medications, so your genotype can affect your treatment options.

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    Determination Of Viral Load

    Quantitative determination of RNA from HCV in human plasma containing K2EDTA was performed using the VERIS MDx system . The RNA-HCV assay has been validated to provide quantitative results of samples containing HCV genotypes 16 . The main characteristics of the HCV infection in patients treated with antivirals are summarized in Supplementary Tables S1, S2.

    Safety And Efficacy Of Glecaprevir And Pibrentasvir In North Tohoku Japanese Patients With Genotype 1/2 Hepatitis C Virus Infection

    Racial Disparities in HCV Incidence and Treatment Outcomes ...

    Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun, Japan

    Correspondence

    Akio Miyasaka, Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 2-1-1, Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.

    Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun, Japan

    Department of Gastroenterology, Iwate Prefectural Kamaishi Hospital, Kamaishi, Japan

    Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun, Japan

    Department of Hepatology, San-ai hospital, Morioka, Japan

    Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun, Japan

    Correspondence

    Akio Miyasaka, Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 2-1-1, Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.

    Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun, Japan

    Department of Gastroenterology, Iwate Prefectural Kamaishi Hospital, Kamaishi, Japan

    Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa-gun, Japan

    Department of Hepatology, San-ai hospital, Morioka, Japan

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