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A very recent systematic review (but from the available bibliographic databases they searched Medline only – and no sign of the strategies used !) in one of the top 5 medical journals to look at currently available molecular diagnostic tests for HCV, their clinical applications, and how these tests shed light on the natural history of HCV.
The authors conclude that: ‘a sensitive nucleic acid test should be used to confirm all cases of acute or chronic HCV infection. A genotype test and quantitative HCV RNA test should be performed on all patients prior to therapy to best assess probability of response and to aid in selection of appropriate therapeutic regimen. Monitoring HCV RNA during treatment provides important information on likelihood of sustained virological response. The same type of quantitative HCV RNA test should be used’.
1 Molecular diagnostics of hepatitis C virus infection: a systematic review.
Scott JD, Gretch DR
JAMA. 2007 Feb 21;297(7):724-32. Review.
PMID: 17312292
This comes from the liver disease research branch, division of digestive diseases an nutrition, national institute of diabetes and digestive and kidney diseases in Bethesda, MD, USA and published in the world’s leading medical journal by the world’s leading experts. These are practice guidelines focusing on adverse effects, economics, pharmacology and therapeutic use of these antiviral agents.
2 Peginterferon and ribavirin for chronic hepatitis C.
Hoofnagle JH, Seeff LB.
N Engl J Med. 2006 Dec 7;355(23):2444-51. Review. No abstract available.
PMID: 17151366
This article focuses on children. Hepatitis C virus infection in children is becoming an increasing challenge to health professionals.
This article from the Leeds St James's University Hospital looks especially at ‘therapeutic use’ and ‘vertical disease transmission’. One of the problems here is that acquiring knowledge of the natural history of HCV infection is made more difficult by the co-morbidity of iron overload, viral co-infection, and chemotherapy.
3 Perinatal hepatitis C virus infection: diagnosis and management.
Davison SM, Mieli-Vergani G, Sira J, Kelly DA.
Arch Dis Child. 2006 Sep;91(9):781-5. Review.
PMID: 16923861
Early identification of patients with acute HCV infection is important for their optimal management. The rate of chronic evolution is 50–90%, and the natural course of chronic hepatitis C can be associated with severe complications such as developing liver cirrhosis and hepatocellular carcinoma. The good news is that the treatment of hepatitis C has dramatically improved over the past decade. This review describes the efficacy and optimisation of the current standard therapy of hepatitis C and its problems in special patient populations. New treatment directions beyond interferon alpha based therapies are on the horizon.
4 Treating viral hepatitis C: efficacy, side effects, and complications.
Manns MP, Wedemeyer H, Cornberg M
Gut. 2006 Sep;55(9):1350-9. Review.
PMID: 16905701
Global estimates talk of 170 million infected individuals with infection leading to cirrhosis, hepatocellular carcinoma, and consequent life threatening complications in 20–30% of infected individuals over a lifetime. Cofactors for disease progression, such as increased age at infection, male sex, and alcohol intake, have been described in multiple large scale studies. However, in marked contrast, there are major gaps in our understanding of the process of acute HCV infection, an event which must necessarily precede the development of chronic disease. There are no reliable or validated data on the incidence of acute infections, either at the national or global level.
5 Acute hepatitis C virus infection: a neglected disease?
Irving WL.
Gut. 2006 Aug;55(8):1075-7. Review. No abstract available.
PMID: 16849345
This is a ‘must read’ from the CDC with lots of references and – interestingly too – full disclosure of all possible conflicts. And it’s ‘Open Access.
The prevalence of chronic hepatitis C virus (HCV) infection in prisons ranges from 12% to 31%. Health professionals do not agree about best practices for identification, medical management, and treatment of hepatitis C in prisoners. The authors report on a January 2003 meeting of experts in prison health, public health, hepatology, and infectious diseases and explore the clinical care, prevention, and collaboration needed to provide hepatitis C management in prisoners.
Of course, staying out of prison is best …but that is tongue in cheek.
6 A framework for management of hepatitis C in prisons.
Spaulding AC, Weinbaum CM, Lau DT, Sterling R, Seeff LB, Margolis HS, Hoofnagle JH.
Ann Intern Med. 2006 May 16;144(10):762-9. Review.
PMID: 16702592
Arecent meta-analysis in Gastroenterology, the top GI journal published by Elsevier and available via HINARI if you are in a ‘so-called’ developing country. Steatosis is a frequent histologic finding in chronic hepatitis C (CHC), but it is unclear whether steatosis is an independent predictor for liver fibrosis.
So…the authors undertook a meta-analysis on individual data from 3068 patients with histologically confirmed CHC recruited from 10 clinical centers from different countries.
They conclude that ‘steatosis is confirmed as significantly and independently associated with fibrosis in CHC’. Just remember, ‘association’ is not ‘causality’.
7 Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data.
Leandro G, Mangia A, Hui J, Fabris P, Rubbia-Brandt L, Colloredo G, Adinolfi LE, Asselah T, Jonsson JR, Smedile A, Terrault N, Pazienza V, Giordani MT, Giostra E, Sonzogni A, Ruggiero G, Marcellin P, Powell EE, George J, Negro F; HCV Meta-Analysis (on) Individual Patients' Data Study Group.
Gastroenterology. 2006 May;130(6):1636-42.
PMID: 16697727
Chronic infection is now the leading indication for liver transplantation in developed nations and will continue to pose an important health and economic burden during the next 10 to 20 years. The authors outline the criteria for screening, diagnosing, and treating patients with hepatitis C virus infection and describe potential future therapies.
Current optimal treatment is pegylated interferon alfa and ribavirin for 24 or 48 weeks on the basis of genotype and virological response.
8 Diagnosis and treatment of chronic hepatitis C infection.
Patel K, Muir AJ, McHutchison JG.
BMJ. 2006 Apr 29;332(7548):1013-7. Review. No abstract available.
PMID: 16644828
A very helpful overview, very recent, from CANADA and ‘Open Access’. With the more than 150 references, many available as full text, it presents a very good overview of the field for primary care physicians. They also review preventive strategies and counseling recommendations.
9 Hepatitis C: a review for primary care physicians.
Wong T, Lee SS.
CMAJ. 2006 Feb 28;174(5):649-59. Review. Erratum in: CMAJ. 2006 May 9;174(10):1450.
PMID: 16505462
These are the top people, in the largest GI society in the world writing in the world’s top GI journal published by the world’s largest medical publisher. This is good. Access free for developing countries via HINARI. This literature review and the recommendations were prepared for the American Gastroenterological Association Clinical Practice and Economics Committee.
10 American Gastroenterological Association technical review on the management of hepatitis C.
Dienstag JL, McHutchison JG.
Gastroenterology. 2006 Jan;130(1):231-64; quiz 214-7. Review. No abstract available.
PMID: 16401486
Here is GUT again and it is free full text – TRAIL stands for: Tumour necrosis factor related apoptosis inducing ligand. The authors investigated the role of TRAIL in viral hepatitis and after alcohol consumption. They identified TRAIL as a new mediator of hepatic steatosis in viral hepatitis and after alcohol intake and they conclude that TRAIL mediated hepatotoxicity has to be considered in patients with viral hepatitis and alcoholic liver disease.
11 Following the TRAIL from hepatitis C virus and alcohol to fatty liver.
Afford SC, Adams DH
Gut. 2005 Nov;54(11):1518-20. Review. No abstract available.
PMID: 16227354
Very good to have a comparison between north and south and developed vs less developed .This can generate insights. This article reviews the published literature concerning HCV transmission through blood transfusions and other unsafe medical procedures. Given the substantial difference in current disease transmission patterns between the northern and southern hemispheres, the situation in developed and developing countries is separately analysed.
The author concludes that: ‘the epidemic continues to spread in developing countries, where the virus is still transmitted through unscreened blood transfusions and non-sterile injections‘.
12 Transmission of hepatitis C virus by blood transfusions and other medical procedures: A global review.
Prati-D.
Journal of Hepatology, 2006, 45/4 (607-616),
PMID 16901579
If you click on ‘full text’ it says: ‘access to the full-text of this article will depend on your personal or institutional entitlements‘. HINARI users have access. Others need an ID and password or $30. You can always email the authors for a copy.
The article emphasizes: Because there is no vaccine and no post-exposure prophylaxis for HCV, the focus of primary prevention efforts should be safer blood supply in the developing world, safe injection practices in health care and other settings, and decreasing the number of people who initiate injection drug use.’ Worth checking also the Safe Injection Global Network at: http://www.who.int/injection_safety/en/
13 Global epidemiology of hepatitis C virus infection.
Shepard-C-W, Finelli-L, Alter-M-J.
Lancet Infectious Diseases 2005, 5/9
558-567
PMID 16122679