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Check out this slideshow for images of herpes, genital warts, gonorrhea, HPV, and more. Very useful!View Thread
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Aim: To determine if simplifying the dosing regimen of RBV impacts outcomes.
Methods: Ninety-two patients on RBP >12 weeks were categorized as follows: Group A
(n = 22): treatment experienced with IFN/PIFN and RBV, Group B (n = 49): treatment
naïve switched to RBP after >12 weeks RBV, Group C (n = 21): treatment naïve on
RBP. Outcomes were compared between RBP and RBV in Groups A and B. Group C
was compared to Group D—a matched control group of RBV-treated patients.
Results: Patients preferred RBP. RBP was associated with improved patient compliance,
less side effects, improved quality of life and a trend toward improved SVR.
Conclusions: RibaPak offers an attractive alternative to RBV.RibaPak blister packs offer an attractive alternative to traditional RBV bottled pills.
Patients prefer RibaPak compared to RBV due to
decreased number of pills, convenience of the blister
pack administration, diminished side effects (primarily
GI) and improved quality of life. RibaPak is associated with
improved patient compliance compared to RBV. This
has the potential to avoid wasted drug costs and reduce
future comorbidity that is associated with significant
health care expense. As the future of HCV treatment
will likely involve the addition of a third drug (such as
a polymerase or protease inhibitor), simplification of
the treatment regimen by a reduction in the number of
pills may be crucial to treatment success.View Thread
Among the 96 treatment-naive patients, the SVR rate was 79% in the triple therapy arm, compared with 61% in the nitazoxanide-pegylated interferon dual therapy arm, and 50% in the standard-of-care arm (P = 0.023).
• Among the 24 treatment-experienced patients, the SVR rate was 25% in the triple therapy arm compared with 8% in the nitazoxanide-pegylated interferon arm.
• RVR, EVR, and ETR rates are shown in the table below (see next study description).
• Adverse events were generally similar across all 3 treatment arms.
• The exception was that the rate of anemia was significantly lower in the group that did not receive ribavirin.View Thread
Table. Factors Affecting SVR Rates
Specific autoimmune blood tests include a check for elevated immunoglobulin levels, specifically an elevated gamma-globulin or immunoglobulin G (IgG) level. Gamma globulin or IgG levels greater than two times the upper limit of normal are highly suggestive of a diagnosis of AIH. In addition, the presence of antinuclear antibody (ANA), smooth muscle antibody (SMA), and the liver kidney microsomal antibody (anti-LKM) must be searched for. As mentioned previously, these antibodies are known as autoantibodies.
____________________________________________________
Autoantibodies do not cause AIH. However, many autoantibodies are produced by the body in people with AIH. ANA and SMA are the most common, and are therefore, considered "markers" of AIH. It should be noted that both ANA and SMA are not specific for AIH. This means they may also occur in liver diseases other than AIH, as well as in diseases of other organs. Approximately 54 percent of people with AIH have both ANA and SMA present in their blood. Other people have one, but not both, of these autoantibodies. ANA occurs alone as a marker of AIH 13 percent of the time and SMA occurs alone as a marker 33 percent of the time. The presence of both autoantibodies is not necessary for the diagnosis to be made. To make things even more confusing - it is possible for people to lack all autoantibodies and still have AIH. This occurs in about 10 - 20 percent of people with AIH. These people are known as autoantibody-negative AIH (type III AIH). (See page xx). It has been found that one or both of these autoantibodies, although not present initially, may appear later in the course of the disease. This is of importance for people who initially test negative for the presence of autoantibodies and thus, have not been given a definitive diagnosis by their doctors.
When ANA and SMA are present in liver diseases other than AIH, their values tend to be very low and are thought to be of little significance. These autoantibodies are reported to doctors on blood work by dilution titers (the dilution of blood containing a specific antibody). A titer of 1:160 (one to one hundred sixty) or greater is considered a high titer and is highly suggestive of a diagnosis of AIH. Titers of less than 1:80 (one to eighty) are considered low titers and are not necessarily indicative of a diagnosis of AIH. Low titers are often found in other liver disorders and are usually not clinically significant. Note that autoantibody titers can fluctuate from one blood test to the next, and during therapy for AIH, they may disappear altogether. Moreover, the levels of these autoantibodies do not correlate with the severity or prognosis of disease.
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In contrast to other liver diseases, such as chronic hepatitis C or hemochromatosis, AIH is a liver disease in which the degree of transaminase elevation and the seÂverity of symptoms often (although not always) correlate with the degree of liver damage and inflammation. Many times, the dramatic improvement of symptoms and normalization of transaminase levels with treatment will essentially prove or confirm the diagnosis of AIH. However, liver function tests (LFTs), autoimmune blood tests, genetic markers, and liver biopsy findings, when evaluated together, in addition to response to therapy, more typically are used to confirm the diagnosis.
Liver Function Tests (LFTs)
Typically, transaminase levels (AST and ALT) are predominantly elevated and GGTP and alkaline phosphatase (AP) are normal or close to normal. If the AP is very elevated in conjunction with normal or only slightly elevated transaminase levels, a diagnosis other than AIH should be considered.
In severe cases of AIH, transaminase levels are very elevated. Transaminase elevations may be as much as ten to twenty times normal values. For example, AST and ALT may be around 400 to 800 IU/L, and the bilirubin level may be around 10 mg/dl. In milder cases, the transaminase levels are only slightly elevated, around 60 to 200 IU/L, and the bilirubin level is normal. In any scenario, when liver function tests are elevated, other more specific blood tests for AIH should be run.
View Thread
Although multiple eye disorders have been found in some people with chronic hepatitis C, a direct association has not been proven. However, all of the following have been reported to have occurred in people with chronic hepatitis C: ulcers in the cornea of the eye, known as Mooren's corneal ulcers; uveitis, which is inflammation of the uvea (the middle layer of the eye); Behcet's syndrome—a syndrome associated with uveitis and ulcers of the mouth and genitalia; and Sjögren's syndrome (dry eyes and dry mouth) have all been reported to occur in people with chronic hepatitis C.
Kidney Disorders
Inflammation of the kidney, known as glomerulonephritis, has been associated with chronic hepatitis C. Occasionally, people with this kidney disorder have either blood or excess protein in their urine.
Musculoskeletal Disorders
Muscle weakness and joint pain have been noted to occur in people with chronic hepatitis C. These people often also have associated cryoglobulinemia. Further study needs to be conducted to confirm these associations.
Other Problems
Other rare, unsubstantiated associations found in people with chronic hepatitis C include pulmonary fibrosis (lung scarring); a type of vasculitis known as polyÂarteritis nodosa (PAN); and vitiligo, a loss of skin pigmentation. Further studies will need to be conducted in order to confirm that these disorders are associated with chronic hepatitis C.View Thread
Skin Diseases
Vasculitis—inflammation of blood vessels—may present (show up during a doctor's initial examination of a patient) as a raised, purplish skin discoloration, known as purpura, which is most commonly located on the legs. This discoloration is due to the leakage of blood under the skin.
Porphyria cutanea tarda (PCT) is a skin abnormality that may present as easy bruising of the skin, in addition to blisters that are sensitive to the sun and bleed easily. Areas of increased or decreased skin pigmentation and increased hair growth, known as hirsuitism, may also be associated with PCT. In addition to HCV, alcohol, excessive iron, and estrogens are believed to precipitate the manifestations of PCT in predisposed people.
Lichen planus is a raised, itchy skin rash that often occurs in the mouth, hair, and nails.
Several other skin changes have been noted to occur in association with chronic hepatitis C, but further study needs to be conducted to clarify their significance.
Hematological (Blood-Related) Diseases
Cryoglobulinemia (excess proteins in the blood) presents with purpura, joint aches (known as arthralgias), and weakness. Cryoglobulinemia may also affect the kidneys, brain, and nerves. Although cryoglobulinemia has been found in approximately 40 percent of all individuals with chronic hepatitis C, only about half of these people experience symptoms related to cryoglobulinemia.
Lymphoma is a malignant tumor of the lymphoid tissue (cells related to the imÂmune system) that has infrequently been found in people with chronic hepatitis C.
Idiopathic thrombocytopenic purpura (ITP) is a disease characterized by an abnormally low platelet count of unclear origin and is generally manifested in the form of a rash. It is believed to be caused by an immune attack on platelets. A consequence of ITP may be a bleeding disorder, as the function of platelets is to facilitate the clotting of blood.
Endocrine Disorders
Thyroid disorders, both hypothyroid (an overly slow thyroid) and hyperthyroid (an overly fast thyroid) have been noted to occur in approximately 5 percent of the individuals with chronic hepatitis C. These disorders often worsen once therapy with interferon (see Chapter 13) has been initiated.
Diabetes—elevated blood sugar (glucose) levels—has been found to be present in many people with chronic hepatitis C in some studies, but further study is needed to confirm this association.
Continued on next resourceView Thread
"The FDAs recognition of this expanded label allows patients failing therapy a safe and efficacious retreatment strategy. The results from this study legitimize how we properly treat these patients helping them to achieve SVR."
"Approximately 50 percent of patients with chronic hepatitis C do not respond to their initial course of therapy," stated Dr. Bruce Bacon, the lead investigator for the registration trial. "The FDAs recognition of this expanded label allows patients failing therapy a safe and efficacious retreatment strategy. The results from this study legitimize how we properly treat these patients helping them to achieve SVR."
The data reported and published in Hepatology (2009) from the U.S.-based, randomized, DIRECT clinical trial (Daily-Dose Consensus Interferon and Ribavirin: Efficacy of Combined Therapy) led to the approval of the expanded label. Results from the DIRECT trial had shown that the use of INFERGEN and RBV is a safe and effective retreatment strategy for patients failing initial therapy with PEG-IFN/RBV. This was especially apparent with interferon-sensitive patients with lower baseline fibrosis scores. In fact, up to 38 percent of non-cirrhotic patients (in the 15mcg arm) who were sensitive to Peg-IFN/RBV and who did not modify their INFERGEN and RBV dosages achieved an SVR. Additionally, patients with cirrhosis were less likely to benefit from retreatment with INFERGEN and RBV unless they displayed previous interferon sensitivity or at least 1-log10 drop in viral levels on prior therapy.
"The expanded labeling for INFERGEN is a significant step forward for retreatment of hepatitis C patients who deserve a second chance to overcome their HCV," stated Patrick Kerrish, R.Ph, M.B.A., President of Three Rivers Pharmaceuticals, LLC. "Our hope is that INFERGEN will become the standard of care for the retreatment of chronic hepatitis C patients."
Three Rivers Pharmaceuticals, LLC is expanding its INFERGEN and hepatitis C education efforts via physician outreach and online patient support programs. An instructional video and guide about proper at-home injections of INFERGEN, tips for patient compliance, access to reimbursement specialists and a hotline staffed by nurse counselors are available at www.infergen.com.View Thread
The programs, educational grants, research awards and fellowships that AASLD supports are vital to finding new treatments for liver diseases and helping to offset the decline in funding available for liver disease research.
If you would like to read more about our current award recipients click here .
Giving Opportunities
The Liver Research Fund
Provides immediate funding for educational grants, research awards, and fellowships.
AASLD Endowment
Provides ongoing support for programs and awards.
New Challenges-New Solutions Campaign
Gifts will build a permanent pool of funds to support Research and Career Development Awards, Advanced/Transplant Hepatology Fellowships, and Single Topic Conferences.
In Dedication
Send a gift on behalf of, in honor of, or in memory of a special person.
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If you would like, feel free to make your donation in honor of, or in memory of, a loved one, significant other, physician, or anyone else that you feel is appropriate. Also feel free to indicate exactly what disease you would like your research dollars to go toward.
Let's all work together to prevent and treat liver disease!
Thanks!
Melissa Palmer, MDView Thread
(pre-registration REQUIRED...it's FREE!!!)
June 26, 2010
9:00 am - 1:00 pm
Seton Hall
Asian Pacific Liver Center @ St. Vincent Medical Center in Los Angeles, CA
FREE REGISTRATION, BREAKFAST & LUNCH, AND HEPATITIS B SCREENINGS!
Brought to you by the Hepatitis B Foundation in collaboration with the Asian Pacific Liver Center at St. Vincent Medical CenterView Thread
Together, we can help one another through these difficult times.
HRSA.gov --Have you heard of HRSA-supported health centers? They care for you, even if you have no health insurance. You pay what you can afford, based on your income. These include dental, immunizations, and mental health care resources.
BenefitsCheckUp.org -- "Many older people need help paying for prescription drugs, health care, utilities and other basic needs. Ironically, millions of older Americans — especially those with limited incomes — are eligible for but not receiving benefits from existing federal, state and local programs."
Free Clinics -- Use the search to find state and local free clinics and see if one is near you.
NeedyMeds.org Clinics --You do not have to provide any documentation to validate your income. You do not have to provide any other form of identification, such as proof of citizenship or "green card."
National Foundation for Dentistry for the Handicapped --"In each state at least one program coordinator is responsible for determining that applicants are either disabled, elderly or medically compromised and have no other way for paying for dental care."
Other--Please make sure and check local resources for tests PAP smear, mammograms, pregnancy testing, prostate cancer screenings, cholesterol screenings, bone density tests, and blood pressure checks. Drug stores, grocery stores with pharmacies, Planned Parenthood, community health centers, local hospitals, senior centers and women's clinics will often have these tests/exams available at low cost or even free. Keep your eyes peeled!
Note: None of these are WebMD sites, so we cannot guarantee content. Clinics may change requirements and/or services offered. Please contact them directly to find current information.
Hope these help!
AndieView Thread
Adding the experimental hepatitis C drug telaprevir to standard interferon /ribavirin therapy cured 75% of newly treated patients, drug maker Vertex announced.
Moreover, most patients taking a 12-week course of telaprevir combination therapy were able to shorten the total length of their grueling treatment from 48 weeks to 24 weeks.
Because hepatitis C virus (HCV) rapidly becomes resistant to telaprevir, the drug must be....(read full article here... )View Thread
A scientist with hepatitis B helps uncover innovative diagnostic procedure as she searches for a cure.
Watch this inspiring video and learn more about liver diseases by visiting the Hepatitis Health Center .View Thread
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