[Viva] Fwd: CATIE News - Exploring the risks of liver cancer after successful treatment for hepatitis C virus

[wendy stevens]

Just checking to see if this is how I post something.
On 2013-06-13 5:49 AM, "Jacqueline" <ja_louis at yahoo.com> wrote:

> Please remove my name from this list.
>
> Sent from my iPhone
>
> On 2013-06-11, at 3:32 PM, Tami Starlight <tamistarlight at gmail.com> wrote:
>
> FYI
>
> Sent from my phone
> All my relations
> Tami Starlight:Unceded Coast Salish territory/Vancouver
> tamistarlight at gmail.com
> http://facebook.com/tamistarlight Tami_starlight (twitter)
>
> Begin forwarded message:
>
> *From:* CATIE <mailer at newsletter.catie.ca>
> *Date:* 11 June, 2013 3:28:12 PM CST
> *To:* "" <tamistarlight at gmail.com>
> *Subject:* *CATIE News - Exploring the risks of liver cancer after
> successful treatment for hepatitis C virus*
>
>     CATIE News - Bite-sized HIV/AIDS news bulletins
>        CATIE News - Exploring the risks of liver cancer after successful
> treatment for hepatitis C virus
>
> In Canada and other high-income countries, in the 1970s and ’80s hepatitis
> C virus (HCV), hepatitis B virus (HBV) and later HIV and other germs were
> sometimes transmitted via transfusion of contaminated blood and use of
> products derived from contaminated blood (such as clotting factors).
> However, thanks to screening of the blood supply, transmission of HCV, HBV
> and HIV via blood or blood products is virtually non-existent in Canada and
> similar countries today.
>
> At present, HCV transmission most commonly occurs in Canada through the
> following means:
>
>    - sharing equipment for substance use, such as needles, syringes,
>    straws and rolled-up currency notes
>    - reusing unsterile equipment for tattooing and body piercing
>    - among men who have sex with men (MSM) – having unprotected anal
>    intercourse, sharing unsterilized sex toys, and not using a new condom with
>    each new partner
>
>  Newcomers to Canada are also at risk for complications from HCV and/or
> HBV if they come from regions where these viruses are relatively common,
> where reuse of needles may have occurred in mass vaccination campaigns, or
> where the blood supply has been contaminated or medical equipment may not
> have been sterilized.
>
> HCV infects the liver. Initially there may be no symptoms or mild symptoms
> of infection similar to the flu. As a result, many people may not be aware
> that they have HCV. Once HCV infection becomes established in the liver, it
> slowly degrades the functioning of this vital organ. Over time, healthy
> liver tissue is replaced by damaged (scarred) tissue in a process called
> fibrosis. Eventually, serious complications can occur, including liver
> failure and in some cases liver cancer. According to a recent report from
> the Canadian Cancer Society<http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance/?region=on>,
> while cases of many cancers are stable or declining, cases of liver cancer
> are on the rise. Unfortunately, there is no vaccine against HCV. For these
> reasons and more, it is important to get tested for hepatitis C, engage in
> behaviours to prevent HCV transmission, and, if infected, get care and
> treatment. Other ways to reduce liver cancer risk include screening for
> hepatitis B virus (HBV) and, if infected, getting treatment. HBV is spread
> in ways similar to HCV. Uninfected people can speak to their doctor about
> vaccination against HBV.
>
> A key goal of treatment for HCV is to quickly suppress the amount of virus
> in the blood and to keep it as low as possible. Achieving and maintaining
> very low levels of HCV in the blood (viral load) is critical to recovery
> from HCV and curing this infection.
>
> The duration of treatment for HCV depends on several factors, including
> the strain of HCV (called the genotype), the presence of co-infections such
> as HIV, and so on. However, what all approved treatment regimens have in
> common is that for recovery from HCV to occur, patients must have what is
> called a sustained virological response (SVR) for 24 weeks after treatment
> has ended. If the amount of HCV in the blood is not extremely low
> (undetectable), recovery is unlikely.
>  The damage left behind
>
> Most clinical trials of HCV treatment have monitored patients up to or
> shortly after they have completed their SVR. This amount of time is
> generally sufficient to assess the effectiveness of treatment. However,
> longer studies are needed to assess changes in liver health and monitor the
> risk for liver cancer. The reason for such additional studies is that while
> effective HCV treatment appears to cure this infection, such treatment,
> particularly if given in the latter stages of HCV disease, does not wholly
> reverse the damage that has occurred to the liver. So although HCV is
> cured, some degree of liver damage and consequent liver disease remains.
>
> To explore the consequences of liver damage in HCV-positive people with
> cirrhosis (severe liver damage), infectious disease and liver specialists
> in Sweden conducted a study. They enrolled 351 HCV-infected people who had
> severe liver damage. Some participants received HCV treatment and were
> cured of this infection. Subsequent monitoring found that cases of
> liver-related complications, liver-related deaths and liver cancer were
> “markedly reduced” after SVR was achieved, compared to participants who did
> not achieve an SVR or who were not treated. However, the researchers found
> that a long-term risk for liver cancer remained in their study
> participants, even in some of those with an SVR. Further findings from this
> study appear later in this *CATIE News* bulletin.
>  Study details
>
> Researchers enrolled participants with HCV between January 2001 and July
> 2009 from six hospitals across Sweden. For the present analysis, they
> focused on 351 participants from their study whose basic profile at the
> start of the study was as follows:
>
>    - 69% men, 31% women
>    - age – 51 years
>    - presence of type 2 diabetes – 20%
>    - 50% had genotype 1 HCV
>    - viral load – 1 million copies
>    - 6 participants were co-infected with HIV
>    - 6 participants were co-infected with hepatitis B virus
>
>  Common features and/or consequences of liver disease in *all*participants were as follows:
>
>    - severely damaged livers (cirrhosis). This diagnosis was based on
>    liver biopsy results or a combination of blood tests, signs/symptoms of
>    liver-related complications and/or CT and MRI scans suggestive of cirrhosis
>    - a buildup of fluid in their abdomen because of elevated blood
>    pressure in the liver’s arteries
>    - internal bleeding
>    - problems with memory and thinking clearly, caused by the buildup of
>    toxins in the blood
>
>  Therapy for HCV infection during the study was a combination of
> interferon and ribavirin.
>
> On several occasions after SVR occurred, participants’ blood samples were
> assessed and retested to confirm continued SVR. Viral load tests used after
> 2006 had a lower limit of detection of 15 IU/ml.
>  Results
>
> Among the 351 participants, responses to HCV therapy were as follows:
>
>    - 31% were treated and achieved an SVR
>    - 55% were treated but did not achieve an SVR
>
>  The remaining 14% of participants were untreated (the reasons for this
> were not disclosed).
>  Liver cancer after SVR
>
> Liver cancer was diagnosed with the help of CT scans. In total, six (5%)
> out of 110 participants who achieved an SVR subsequently developed liver
> cancer over an average observation period of five years. In two cases, the
> diagnosis of liver cancer occurred less than a year after SVR was achieved.
> This suggests that the cancer had been present for some time—and was likely
> present during treatment when it went undiagnosed.
>  Liver cancer in people without SVR
>
> Among participants who did not experience an SVR, cases of liver cancer
> were at least twice as high as among participants who did achieve an SVR.
>  Factors linked to liver cancer
>
> Age was one factor statistically linked to the development of liver
> cancer. People who were older than 50 years were at increased risk for this
> cancer compared to younger people. People who were 60 years old were at
> even greater risk than younger people. This heightened risk with age is a
> factor of the time that someone has been infected with HCV (older people
> are more likely than younger people to have had HCV for a longer time). The
> longer a person has HCV, the greater the chances of liver damage and for
> abnormal liver cells to be transformed into cancer cells. The other factor
> linked to an increased risk of cancer was being male.
>  Liver-related complications
>
> The risk for developing any liver-related complications was very low among
> participants who achieved an SVR. The main complication was ascites—an
> accumulation of fluid in the abdomen.
>
> Among people who did not achieve an SVR or who were untreated, the risk
> for developing liver-related complications was elevated.
>  Survival
>
> Overall, 10% (11 people) of participants with an SVR died during the
> course of the study. Four of these deaths were from complications due to
> liver cancer. The other causes of death included other cancers, such as
> those affecting the lungs and pancreas gland, as well as causes unrelated
> to cancer, such as infections.
>
> Among participants who did not develop an SVR or who were not treated, 22%
> (52) died from liver-related causes.
>  The importance of an SVR
>
> The findings from the Swedish study underscore the general importance of
> achieving an SVR with HCV treatment. Not only does this event mean that HCV
> has been cleared but it reduces the future risk for developing
> liver-related complications and improves the chances of survival among
> people with cirrhosis.
>  HCV and liver health
>
> Some previous studies have found that scarred liver tissue can partially
> regress and healthy tissue can regenerate after an SVR. It would have been
> interesting to assess the possibility of a link between the amount of
> scarred liver tissue and the future risk of developing liver cancer.
> However, in the present study researchers did not assess changes in the
> liver to determine whether or not scar tissue had regressed.
>
> What is clear from the present study is that achieving an SVR helps to
> clear HCV infection and improves future chances of survival. However, an
> SVR does not mean that damaged liver tissue disappears. People with
> cirrhosis who have achieved an SVR will likely need regular monitoring to
> keep abreast of any developing tumours. Long-term studies are also needed
> to help doctors determine which of their patients with cirrhosis who have
> achieved an SVR are at heightened risk for developing liver cancer.
>
> *Resources*
>
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