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Friday, November 25, 2016
Smoke & Mirrors: The Effect of Tobacco Smoking on HCV Disease Progression
This week someone shared a news item on HIV and smoking with us, “Smoking more harmful than HIV for people taking effective treatment, US study suggests,” and it got me thinking about the relationship between smoking and HCV.
According to the above article, a study this month in the Journal of Infectious Diseases (November 2016) found that “Smoking has the potential to shorten the life of a person taking HIV treatment by an average of six years, and is far more harmful to the life expectancy of people living with HIV than well-managed HIV infection itself. The study found that stopping smoking improved life expectancy, with the greatest gain in life expectancy seen when smoking was stopped by the age of 40.”
Dr Rochelle Walensky of the Massachusetts General Hospital Division of Infectious Diseases, senior author of the study, said, “It is time to recognise that smoking is now the primary killer of people with HIV who are receiving treatment.” Smoking reduces life expectancy through cardiovascular disease (stroke and heart attack), cancers and chronic obstructive pulmonary disease (emphysema).
Whew!! Okay, so where does that leave people with HIV-HCV coinfection or just with HCV who smoke, especially in terms of liver-related damage, because there have been studies which showed that smoking was directly related to liver damage and liver cancer. Those of us involved in advocacy and support all know plenty of people who smoke tobacco, and it makes me sad when I hear them coughing and knowing that many also have cirrhosis. The last thing I want to do is badger a smoker about smoking: It just doesn’t work! But on the other hand standing by watching people I know killing themselves leaves me in a moral and emotionally conflicted state.
There seems to be a general consensus that smoking has multiple effects on factors influencing hepatitis C and antiviral therapy, including lipid metabolism, fibrosis, platelet count and adherence aspects, and that smoking and HCV are independent risk factors for liver cancer (HCC). However a NEW study from the Canadian Coinfection Cohort on HIV-HCV coinfection that focussed on smoking and liver disease progression seems to have turned this all on its head!
So: I decided to try to make sense of all of this and find out if smoking was really bad for people with HCV. I mean we all know that smoking isn’t any good for you, but if you have HCV will it kill you faster? And this is what I found out. Read more…..http://hepcbc.bchep.org/2016/11/25/smoke-mirrors-effect-tobacco-smoking-hcv-disease-progression/
Other News
Compensation funds for tainted blood victims short more than $220-million
The fight for compensation over the decades-old tainted blood scandal has taken another turn for the worse for Canadians who contracted hepatitis C.
Back in June, the fight was over a $250 million surplus in one victims’ compensation fund and a $65 million hole in another, but now there’s a $220 million dollar shortfall for what’s known as the pre 86-post 90 fund.
That’s according to a new report by the federal government, and Lawyer David Klein says the courts don’t have the power to order the funds to be topped up.
Frequent fliers have same cancer risk as obese people: Jet lag ‘drives up bile acid in the liver – and could be behind global spike in diagnoses’
A study by Baylor College of Medicine has tracked how jet lag affects the liver. They found it creates bile acid buildup akin to that seen in obese people. Experts warn this drives up cancer risk for frequent fliers and shift workers. Frequent fliers have the same cancer risk as obese people, according to a new study. Jet lag drastically raises one’s risk of liver cancer by driving up bile acid levels in the liver, creating buildup akin to that seen in organs of clinically overweight people. Researchers also point to the spike in people jet-setting as a reason for the rocketing rates of liver cancer across the world.
Primary care providers can effectively treat patients with hepatitis C
Primary care providers such as non-specialist physicians and nurse practitioners can be quickly trained to provide direct-acting antiviral (DAA) therapy for hepatitis C with a high level of treatment success and provider satisfaction, according to a presentation at the 2016 AASLD Liver Meeting this month in Boston.
The advent of direct-acting antivirals used in interferon-free regimens has made treatment for chronic hepatitis C much more effective. In addition, DAA treatment is shorter — typically 8-12 weeks instead of 12-24 months — and simpler because it does not require interferon injections and management of its many side effects.
In addition to the cost of the new DAA drugs, another barrier to expanded access to treatment is that there are not enough liver disease specialists to treat everyone with hepatitis C. But specialized treatment may not be necessary for most patients with uncomplicated disease in the DAA era.
U.S.: Settlement Reached on Washington State Medicaid Denial of Pricey Hep C Drugs
A class suit representing about 28,000 Medicaid patients was filed against the Health Care Authority in February, alleging that 900 people in the state had been denied access to curative treatment based on their fibrosis score. A preliminary injunction was issued in May, barring the state from denying coverage based on fibrosis score. If approved, the settlement agreement would make that change permanent, opening access to medically necessary treatment to all hep C patients covered by Medicaid. Let’s hope the domino effect reaches up into Canada!