Depression halves hep C treatment success
People who are depressed before starting interferon-plus-ribavirin therapy for hepatitis C are only half as likely to achieve treatment success as those who aren’t depressed, a US study reported recently.
The investigators reported on the rate of Sustained Virological Response (SVR, equivalent to a cure) amongst 694 patients treated at the hepatitis C clinic in Albuquerque, New Mexico.
A quarter of the patients were assessed as having depression before starting therapy. These patients were 50% less likely to achieve an SVR than patients who started off without depression.
Another 41% of patients developed depression while on interferon – a well-known side effect – but those who achieved an SVR were 27% less likely to develop it.
The fact that baseline (pre-treatment) depression is a predictor of treatment failure shows that failure isn’t being caused by treatment side effects, but may indicate that already-depressed people may need careful assessment and additional support for factors like adherence if they are to benefit from hepatitis C treatment.
“The impact of depression is important for the clinician to assess when evaluating a patient for HCV treatment,” the researchers write.
47th ICAAC Conference, 2007. Abstract V-1898.
Aussie pozzies also catching hepatitis C
Hepatitis C (HCV) infection amongst HIV positive gay men is not restricted to Europe. An Australian study has found that over a quarter of cases of recently-acquired hepatitis C were amongst gay men with HIV, most of whom cited sex with other men as their only risk factor. In fact every one of the 26 cases of acute HCV detected amongst HIV positive people in the ATAHC (Australian Trial of Acute Hepatitis C) Trial was in a gay man whose main risk factor was sex.
In contrast only one out of 94 HIV negative people in the same trial said that sex with another man was his most likely infection route.
The trial involves 21 clinics monitoring cases where patients are detected with acute hepatitis C and then following their medical progress.
It’s not a randomised trial. This means that more cases of hep C might be detected in people with HIV because they attend clinics more frequently, which might overstate the frequency of hepatitis C infection in both gay men and in people with HIV relative to the general population. Nonetheless the nearly 100-fold difference in infection rates between gay men with and without HIV suggested to the researchers that there might be something about HIV infection that makes gay men much more susceptible to infection through sex.
“The potential mechanisms for increased rates of sexual transmission of HCV in the HIV positive population may involve higher serum [blood] and semen HCV viral loads, impaired immunity, and also unique high-risk sexual behaviours,” they write. They call for further analysis to find out whether poz gay men’s vulnerability is more due to behaviour or to medical factors.
The study, they add, shows that “factors driving the epidemiology of acute HCV infection amongst HIV positive gay men are prevalent globally.”
•AIDS 45:2112-13.
Image: Hepatitis C cell
Coffee cuts cancer
Drinking coffee halves your risk of developing liver cancer, an analysis of studies has found. Nine studies surveying the incidence of liver cancer in the general population in Japan and Europe found that coffee drinkers were 43% less likely to get the disease than non-drinkers, and that heavy coffee consumers were 55% less likely. People with pre-existing liver disease seemed to derive more benefit. The association was statistically significant in two-thirds of the studies. The cause remains mysterious, but coffee’s protective effect was independent of other cancer risks like smoking, drinking alcohol or having hepatitis B or C.
Heroin increases hepatitis risk
Morphine and other opiate drugs make liver cells more vulnerable to hepatitis C infection, a US study has found. This helps to explain why the virus spreads so rapidly between injecting drug users who share needles. Dr Wen-Zhe Ho from Philadelphia found that morphine reduced liver cells’ ability to produce the natural antiviral defence chemical interferon-alpha. The drugs also weakened the protective effect of the interferon that was produced, leading to more vulnerability both to acute infection and to developing chromic liver disease.
Pegasys and PegIntron are equal
The two brands of pegylated interferon, Pegasys (made by Roche) and PegIntron (made by Schering-Plough) are just as effective as each other, a Spanish study has found. A study of 568 patients taking either formulation found that 32.7% of patients on Pegasys and 31.4% on PegIntron achieved a Sustained Viral Response, i.e. treatment success. There were also equal numbers of deaths, liver failure and treatment discontinuation due to side effects. Slightly more patients with the hard-to-treat HCV type 1 and 4 achieved an SVR on Pegasys than on PegIntron (19% versus 14%) but this was due to a higher proportion of PegIntron patients having advanced liver disease (42%, versus 33% on Pegasys).
Hep C raises diabetes risk
Having hepatitis C increases the risk of developing diabetes by 70%, a study from Taiwan has found. The study followed nearly 5000 over-40s for seven years to see if they developed type II diabetes. Of these, 16% had hepatitis C, 11% had chronic hepatitis B, and just over 2% had both. Just under 10% developed diabetes over this period but the rate amongst people with hepatitis C was 14-15%, whether or not they had hepatitis B too. In contrast, hepatitis B by itself conferred no extra risk. The only other risk factors for diabetes were age and obesity. The researchers recommend that diabetes screening should be started earlier in people with hepatitis C than among the general population.
