Grace M. Chee

Comorbidities associated with the increasing burden of hepatitis C infection.

Background: Hepatitis C virus (HCV) infection is implicated in an increasing number of liver transplantations, hospitalizations and healthcare costs.

Tobacco and other factors have a negative impact on quality of life in hepatitis C patients.

Summary.  Hepatitis C virus (HCV) is known to adversely affect general, social, emotional and mental health domains. This study was designed to identify variables that may be associated with these measurable outcomes. We conducted a cross‐sectional retrospective review of demographic and clinical data from 800 patients with HCV evaluated between January 1998 and November 2007. Data were collected using a standardized questionnaire filled out by the patients at the first encounter. Variables evaluated included fibrosis stages (i.e. FS0/1/2 vs FS3/4), demographics, comorbid health conditions, tobacco and alcohol use, high‐risk social behaviours and laboratory data. Variables assessed were depression, fatigue, problems sleeping and loss of interest in sex. Statistical analysis was performed using univariate and multivariate logistic regression. Depression (29.3%) in our HCV study population was associated with female gender, tobacco use, hyperlipidemia, history of heavy alcohol use and intravenous drug use. Fatigue (44.6%) was associated with end‐stage renal disease, past and current tobacco use and current alcohol use. Difficulty sleeping (13.8%) was associated with past and current tobacco use, current alcohol use and diabetes. Loss of interest in sex (7.7%) was associated with current tobacco use, multiple risk factors for HCV and age at time of evaluation. Fibrosis stage (FS) also had a significant positive association with alcohol use (OR 2.61; P = 0.003) and tobacco use (OR 2.00; P = 0.002). Smoking and alcohol use have a significant negative impact on the presence of depression, fatigue, difficulty sleeping and loss of interest in sex in HCV patients. Practitioners should be aware of these associations, particularly tobacco use, which significantly and negatively impacted every variable evaluated.

Interferon Free Hepatitis C Treatment Regimens: The Beginning of Another Era

Hepatitis C is a virus affecting millions worldwide and is a major health risk. With the potentially severe adverse event profile of the current backbone of therapy, interferon, there is an impetus to discover interferon free treatment regimens. With the development of new oral direct acting antivirals, interferon free regimens may be available in the next few years. This article discusses some of the preliminary data from interferon free studies.

Viral Resistance in Hepatitis B: Prevalence and Management

Hepatitis B is a DNA virus affecting hundreds of millions of individuals worldwide. As the clinical sequelae of cirrhosis and hepatocellular cancer are increasingly recognized to be related to viral levels, the impetus increases to offer treatment to those previously not treated. With the development of more robust antivirals with reasonable safety profiles, long-term treatment is becoming more common. The oral nucleos(t)ide analogs have become the preferred first-line therapies for most genotypes of hepatitis B. Five are now available, all with different potencies and resistance profiles. Long-term data spanning several years are now available for most compounds in this arena. This article focuses on the common natural variants and those secondary to nucleos(t)ide therapy, as well as diagnostic methods to detect resistance.

Taribavirin: a potential alternative to ribavirin

Pegylated interferon and ribavirin are currently the standard of care therapy for chronic hepatitis C. In the near future, protease inhibitors are likely to be part of a three-drug regimen with interferon and ribavirin. It is not yet clear if therapy duration will be shorter, but it appears that anemia will be more severe. Ribavirin has to date been proven indispensible as a member of the treatment regimen, despite the potentially dangerous side effect of anemia. Taribavirin (viramidine), a purine nucleoside analog, is a prodrug of ribavirin. In a Phase III registration trial, it failed to show adequate efficacy but did have significantly less anemia when compared with weight-adjusted ribavirin. The dosing of taribaivirin may have been the flaw of that study, and indeed interim results of a Phase IIb study currently underway appear to have better antiviral effects with weight-based dosing. Sustained viral response rates comparable to ribavirin in a larger prospective study will be needed to supplant the c...