Tag Archives: Hepatitis C

Push to Screen, Treat Baby Boomers for Hepatitis C Virus

In 2012, the U.S. Centers for Disease Control (CDC) recommended one-time screening for hepatitis C virus (HCV) for all adults born from 1945 to 1965 – the “baby boomers.”1 Pennsylvania and New York state legislatures have passed laws making it mandatory for health care providers to offer HCV screening or diagnostic testing for all baby boomer patients.2,3 According to Thomas R. Riley, III, MD, gastroenterology and hepatology, Penn State Health Milton S. Hershey Medical Center, “We just aren’t seeing the numbers of HCV cases that we know are out there in this population; this tells us that it isn’t being detected.” Continue reading

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Ultrasound-based Elastography for Non-Invasive Monitoring in Chronic Liver Diseases

Non-invasive, ultrasound-based elastography devices are changing and simplifying regular monitoring for scarring and fibrosis in patients with certain chronic liver diseases, in many cases replacing the need for biopsy.1 Karen L. Krok, M.D., Penn State Hershey Gastroenterology and Hepatology, says, “In patients with an established diagnosis of chronic liver disease, such as hepatitis C or B or nonalcoholic steatohepatitis (NASH), elastography can be used to monitor fibrosis and scarring, with a level of accuracy comparable to biopsy. The procedure is quick, painless and less expensive.”

Ultrasound-based methods of elastography use a vibrating device attached to an ultrasound transducer, which is placed in an intercostal position with the patient lying supine. The velocity of vibration waves (also called shear wave velocity), expressed in kilopascals (kPa), is determined by measuring the time the vibration wave takes to travel to and bounce back from the liver. Shear wave velocity is directly related to tissue stiffness, an indicator of hepatic fibrosis (Figure). Ten successful measurements are required for the test to be reliably interpreted; a median value is generated to indicate the degree of liver fibrosis. Krok says, “It’s like bouncing a tennis ball against a soft versus hard surface. The ball will bounce back more quickly from a firm surface like pavement than it would if it were bounced against something soft, like a pillow.” Continue reading

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Interferon-Free Regimens Offer the Potential of Hepatitis C Cure

For a quarter century, hepatitis C was a dreaded diagnosis, linked to long, grueling treatment regimens and poor outcomes. Dramatic gains, however, have been witnessed since the approval in 2011 of the protease inhibitors boceprevir and telaprevir – the first of the “directly acting antiviral agents.”

“With the addition of boceprevir or telaprevir to interferon and ribavirin, cure rates of about 70 percent were seen after only six months of treatment,” says Ian Schreibman, M.D., of Penn State Hershey Gastroenterology and Heptology. The fast pace of successful drug development has not slowed, and now interferon-free regimens are being studied, with cure rates of more than 90 percent. “We’ve turned the tables on hepatitis C. The potential to completely eliminate it is now on the horizon, similar to what occurred with polio during the twentieth century,” says Schreibman. Continue reading

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New Developments in the Rapidly Evolving Landscape of Hepatitis C Therapy

Hepatitis C is one of the most dreaded conditions in the United States today, affecting approximately 2 percent of the population. It remains the most common cause for liver transplantation in the United States; 10,000-20,000 patients with hepatitis C die annually. Standard interferon/ribavirin regimens are given for six to twelve months, and only yield a cure rate of 40-50 percent. Furthermore, patients face a high risk of side effects, including, but not limited to, thyroid abnormalities, retinopathy, pancreatitis and blood cell dyscrasias.

Fortunately this clinical picture has brightened considerably in the last two years. Leading hepatologists in the United States and around the world, including those at Penn State Hershey Medical Center, have helped to usher in a new era in hepatitis C treatment. Based on Phase III trials for which Penn State Hershey served as an investigational site, the protease inhibitors boceprevir and telaprevir were approved in 2011. Ian Schreibman, M.D., associate professor of medicine, Division of Gastroenterology, Department of Medicine points out, “Unlike interferon, boceprevir and telaprevir directly disrupt the viral replication cycle. When combined with interferon and ribavirin, dramatically higher cure rates of about 70 percent were seen using a regimen only half as long (about six months). This represents a true paradigm shift in hepatitis C treatment.” Continue reading

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