February Mid-Month

17
February 2015 • Vol. 18, Issue 2.5
The Global Spread of Genotype 1
—Alan Franciscus, Editor-in-Chief
T
he origin of hepatitis C
(HCV) is unknown. The
current theory is that it may
have originated in horses, but
while the virus found in horses
is similar to the hepatitis C
virus the scientific evidence
linking it to hepatitis C is far
from clear. Where the virus
originated is on more solid
ground—it is believed to have
originated in West Africa.
Hepatitis C is spread by direct
blood-to-blood contact. So
how did it develop into such
a huge problem with an estimated 130-150 million people
infected worldwide? How did
genotype 1 become the most
common genotype worldwide? The answer to both
questions is well-known—
blood transfusions and unsafe
injections.
In the study “The Global
Spread of Hepatitis C Virus
1a and 1b: A Phylodynamic
and Phylogeographic Analysis,” by G Magiokinis et al.,
the authors used a complicated system of analysis with
various models (molecular
clock & the Bayesian skyline
demographic). The model
tracked how genotype 1a
and 1b spread throughout the world. First it was
found that genotype 1a had
a steady rate of expansion
from about 1906 through
the 1960’s. Moreover, it was
found that from the 1960’s
through the 1980’s it dramatically expanded. This
corresponds to the increase
in injection drug use from the
1960’s through the present
day.
Genotype 1b on the other
hand expanded at a steady
rate from 1922 to the late
1940s. Then from the 1950’s
until the 1980s it showed the
greatest expansion. Thus, the
highest rate of expansion of
genotype 1b was ~16 years
before genotype 1a. An
interesting observation was
that early on in the hepatitis
C epidemic it was thought
that genotype 1b led to more
cases of liver cancer. A possible explanation of this is
that people with genotype 1b
were infected longer and were
more likely to have had more
disease progression. As
the authors pointed out, the
connection between genotype 1b, liver cancer and the
earlier spread of genotype
CONTINUED ON PAGE 6
IN THIS ISSUE
HERBAL SUPPLEMENT CRACKDOWN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
THE FIVE: Sleep and Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
WHAT’S NEW! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
DISABILITY & BENEFITS: Reallocation; ACOs; ABLE Accounts (Update on Federal Government Actions) . . . . . . . . . . . . . . . . 7
SNAPSHOTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Herbal Supplement Crackdown
—Alan Franciscus, Editor-in-Chief
O
n February 3, 2015,
the New York State
Attorney General’s office
announced that four major chains (GNC, Target,
Walmart, and Walgreens)
were selling herbal supplements that could not be verified to contain the labeled
substances in the listed ingredients. Worse yet, many
of the substances tested
and found were not listed on
the labels. The letters sent
out by the State Attorney
General ordered the retailers
to immediately stop selling
the supplements.
What most people do
not realize is that herbal
supplements are not regulated to protect consumers.
New York state is introducing a bill to regulate herbs
and supplements.
In the brands tested
only 21% had verified ingredients that were listed
on the product label. The
remaining 79% contained
other fillers that included
rice, beans, pine, citrus, asparagus, primrose, wheat,
houseplants, wild carrot,
and other fillers. These
could be potentially dangerous to people with aller-
2
gies to these substances.
Of note, one sample contained only 4% of the particular ingredient that was
listed on the label.
The bigger question is:
How is a person to know
what herb or supplement to
trust? There are a couple
of options—some require a
paid subscription. But the
cost could well be worth
an investment to make
sure that the herbs and
supplements are of stated
potency and dollar value:
• Consumerlabs.com is
a useful resource for
herbs (paid subscription
required).
• The German E Commission has information
about the safety of herbs.
However, it has not been
updated since 1994, but
some still consider the
information valid.
• A m e r i c a n B o t a n i c a l
Council is a resource
for herbs in general and
houses an English version of the German E
Commission as well as
an expanded version issued in 2000 (paid subscription required).
• HCV Advocate has an
Herbal Glossar y and
Fact Sheets that we are
in the process of updating.
• Amazon.com sells many
books on herbs that
provide some information about drug-drug
interactions.
Always tell your medical
provider of any supplement
or herb (prescribed or overthe-counter) that you are
currently taking for potential drug-drug interactions.
The Full Prescribing Information for a particular
Food and Drug Administration (FDA) approved
drug lists all the possible
drug-drug interactions. For
instance, St. John’s wort (a
common herb) should not
be taken when people are
being treated with HARVONI or VIEKIRA PAK. All
of the ‘Labels’ can be found
on our website http://www.
hcvadvocate.org/hepatitis/
treatment.asp#FDAPI
While the tests were
conducted just in New
York State (in 13 regions)
it is likely that the same
CONTINUED ON PAGE 3
Supplements FROM PAGE 2
ingredients are similar to
store brands found in other
states. The tests were conducted using a DNA testing
technique performed by
Dr. James A. Schulte II of
Clarkson University in Potsdam, N.Y. on samples purchased at the stores from
across New York State.
I have copied the information from the New York
Attorney’s press release
about the herbal preparations tested.
GNC:
• Six “Herbal Plus” brand
herbal supplements per
store were purchased
and analyzed: Gingko
Biloba, St. John’s Wort,
Ginseng, Garlic, Echinacea, and Saw Palmetto.
Purchased from four
locations with representative stores in Binghamton, Harlem, Plattsburgh
& Suffolk.
• Only one supplement
consistently tested for
its labeled contents:
Garlic. One bottle of Saw
Palmetto tested positive for containing DNA
from the saw palmetto
plant, while three others
did not. The remaining
four supplement types
yielded mixed results,
but none revealed DNA
from the labeled herb.
• Of 120 DNA tests run
on 24 bottles of the
herbal products purchased, DNA matched
label identification 22%
of the time.
• Contaminants identified included asparagus,
rice, primrose, alfalfa/
clover, spruce, ranuncula, houseplant, allium,
legume, saw palmetto,
and Echinacea.
“What most people do
not realize is that herbal
supplements are not regulated
to protect consumers.”
Target:
• Six “Up & Up” brand
herbal supplements per
store were purchased
and analyzed: Gingko
Biloba, St. John’s Wort,
Valerian Root, Garlic,
Echinacea, and Saw
Palmetto. Purchased
from three locations with
representative stores in
Nassau County, Poughkeepsie, and Syracuse.
• T h r e e s u p p l e m e n t s
showed nearly consistent
presence of the labeled
contents: Echinac ea
(with one sample identifying rice), Garlic, and Saw
Palmetto. The remaining
three supplements did
not reveal DNA from the
labeled herb.
• Of 90 DNA tests run
on 18 bottles of the
herbal products purchased, DNA matched
label identification 41%
of the time.
• Contaminants identified
included allium, French
bean, asparagus, pea,
wild carrot and saw palmetto.
Walgreens:
• Six “Finest Nutrition”
brand herbal supplements per store were
p u rc h a s e d a n d a n a lyzed: Gingko Biloba,
St. John’s Wort, Ginseng, Garlic, Echinacea, and Saw Palmetto.
Purchased from three
locations with representative stores in Brooklyn,
Rochester and Watertown.
CONTINUED ON PAGE 10
3
The Five: Sleep and Insomnia
A
good night’s sleep is
a critical component
of living healthy especially
with hepatitis C. As any
insomiac will tell you, getting a restful night’s sleep
may be one of the most
difficult goals to achieve,
but man when you get one
it’s like achieving nirvana!
Recently, the National Sleep Foundation released new recommendations for Americans of
every age. While these
a re re c o m m e n d a t i o n s ,
there are always reasons
why people may require
more sleep than recommended. For instance, if
you have an illness or are
being treated for hepatitis
C your body needs more
sleep than recommended
to heal and recover.
1 . T h e N at i o n a l S l e e p
F oundation recommends
the following hours of
sleep every day:
• N e w b o r n s ( 0 - 3
months): 14-17 hours
• Infants (4-11 months):
12-15 hours
4
• Toddlers (1-2 years):
11-14 hours
—Alan Franciscus, Editor-in-Chief
• P r e s c h o o l e r s ( 3 - 5
years): 10-13 hours
• School-age children
(6-13): 9-11 hours
• Teenagers (14-17):
8-10 hours
• Yo u n g A d u l t s &
Adults (18-64): 7-9
hours
• Older Adults (65+):
7-8 hours
2. C a u s e s o f i n s o m n i a :
There are many causes of
insomnia or sleeplessness
including:
• Living with hepatitis
C and the uncertainty
of life with a potentially deadly illness
• People who are on
HCV treatment may
worry about being
cured
• Sleep Apnea (a medical condition that interferes with people’s
breathing while they
sleep)
• Certai n pres cri bed
and over-the-counter
medications
• A sleeping partner
who snores or is rest-
less (including pets)
• To o m u ch a lc ohol,
nicotine, caffeine,
too little or too much
food before bedtime
• C h a n g e i n w o r k
schedule
• Traveling long distances, travel across
time zones, and
many, many more
reasons
3 . C o m p l i c at i o n s
I nsomnia :
of
• Anxiety and depression
• Slow reaction times
and poor work performance
• Irritability
• I n c r e a s e d r i s k f o r
high blood pressure,
heart disease, and
diabetes
• Substance use
• Overeating and obesity that could lead to
fatty liver
4. S elf -H elp T ips :
• Limit caffeine, soda,
tea, chocolate
CONTINUED ON PAGE 5
FROM PAGE 4
• Use earplugs and eye
masks to block noise
and light if needed.
insomnia can benefit from
a sleep study to determine
if they have sleep apnea
or another sleep disorder.
A symptom of sleep apnea
is being tired during the
day—the same symptom
that is the most common
symptom of hepatitis C.
Treating sleep apnea can
improve everyone’s quality of life especially those
with hepatitis C.
Don’t live your life full
of sleepless nights—practice self-help strategies
and get medical help as
needed to live life to the
fullest. No one should
live a life full of sleepless
nights and days full of being tired. Get tested. Get
treated. Get Cured.
• Tur n off your mind
when going to
sleep—try relaxation
techniques and tapes
Check Out These Sleep
and Insomnia Fact Sheets
• Avoid or cut back on
alcohol and tobacco
especially too close
to bedtime
• Go to bed the same
time every night.
Have a consistent
routine when preparing for bed—brush
teeth, read a book—
this tells your mind
and body you are
ready for bed
• Make sure your bed/
pillow is comfortable
• Don’t go to bed hungry, but don’t eat a
large meal too close
to bedtime
• If you cannot sleep,
get up do something
boring and go back
to bed.
5. M edical care : There
are many over-the-counter and prescription medications that can treat
chronic insomnia. People
who suffer from chronic
• Easy C Facts: Sleep
• E a s y C F a c t s : S i d e
Effects – Insomnia
Executive Director
Editor-in-Chief,
HCSP Publications
Alan Franciscus
alanfranciscus@hcvadvocate.org
Managing Editor, Webmaster
C.D. Mazoff, PhD
cdmazoff@hcvadvocate.org
Contributing Authors
Jacques Chambers, CLU
Design
Leslie Hoex
Blue Kangaroo Design
blueroodesign@aol.com
Contact information:
Hepatitis C Support Project
PO Box 15144
Sacramento, CA 95813
The HCV Advocate offers
information about various forms of
intervention in order to serve our
community. By providing
information about any form of
medication, treatment, therapy or
diet we are neither promoting nor
recommending use, but simply
offering information in the belief
that the best decision is an
educated one.
Reprint permission is granted and
encouraged with credit to the
Hepatitis C Support Project.
© 2015
Hepatitis C Support Project
• HCSP Fact Series: Sleep
5
Genotype 1
FROM PAGE 1
1b needs to be validated in
future studies.
To validate their findings
of the earlier expansion of
genotype 1b, however, the
authors pointed to other
evidence:
• All US military recruit
samples from 1948-1955
were genotype 1b.
• Older HCV-infected individuals are “systematically” or consistently
genotype 1b.
Back to why genotype 1 is
the most common genotype.
The most likely reason is that
genotype 1 was introduced
into developed western
countries and spread by the
introduction of blood transfusions, plasma pooling and
unsafe injections (reuse or
improper needle sterilization)
of medicines to treat many
diseases. In the late 1920s
through the present day the
epidemic of injection drug
use and sharing needles and
drug preparation tools is another reason for the spread
of HCV genotype 1.
One has to wonder how
different it would be if genotype 2 had been ‘the genotype’ that had been the one
6
that had greatly expanded
instead of genotype 1. Treatment of genotype 2 produced very high cure rate
early on in the history of treatment. Still with current treatments we have the potential
to eradicate hepatitis C in
a lifetime. If only we could
increase treatment access
for everyone with hepatitis C.
Facts about genotype 1:
• Genotype 1 is the most
common genotype
worldwide at 83.4 million
(46.2%) people.
• Genotype 1 is the most
common genotype in the
United States at 70% of
the population with HCV.
• Genotype 1a and 1b are
the most common subtypes; subtypes 1c, d, e,
f, g, h, i, k and l have been
identified but are uncommon.
• The current standard of
care for the treatment of
hepatitis C can cure 90 to
100% of people who take
the medications (HARVONI and VIEKIRA PAK).
Treatment durations are
usually 12 weeks but vary
from 8 to 24 weeks.
We have recently updated many
of our fact sheets and our newly
designed drug pipeline:
• Drug Pipeline: We have added
drugs in development or added
additional information about
drugs already listed at http://
hcvdrugs.com/
• Fact Sheets: In addition to
the fact sheets listed in the
newsletter, we have reviewed
and updated the following fact
sheet series:
Being an Effective Healthcare
Consumer
• Calling your Medical Provider
• Choosing a Medical Provider • Getting Organized for the
Health of It
• Maximizing Your Medical Appointments
• Medical Appointments • Tips for Lowering Prescription
Drug Costs
HCV and Mental Health • Overview of Depression
• Depression: Self-Help Tips
• HCV and Depression • HCV and Mental Health Resources
• Managing Depression • Medical Treatment for Depression H C V Tr a n s m i s s i o n a n d
Prevention • Transmission and Prevention of
HCV Overview
• Environmental Stability of HCV:
How Long Does HCV Live on
Surfaces and in Syringes?
• HCV & Tattoos
• Occupational Exposure to Hepatitis C • Personal Care Settings
• Sexual Transmission of HCV
Reallocation; ACOs; ABLE Accounts
(Update on Federal Government Actions)
—Jacques Chambers, CLU
T
his column normally focuses on benefits issues,
not politics; but government
actions have a large impact
on benefits and the disabled
persons who receive them.
This month’s article takes a
look at three actions by the
federal government that directly affect people dealing
with disability, namely:
• Reallocation of funds
between Social Security
trust funds, which could
have a dramatic effect on
anyone collecting Social
Security Disability;
• Accountable Care Organizations (ACOs) under
Obamacare which looks
to become an effective
tool at reducing medical
costs; and,
• Enactment of ABLE accounts, a recent federal law which could help
disabled persons save
money tax-free.
Reallocation of
Trust Funds
This is the item that could
have the quickest and most
severe impact on people
collecting Social Security
Disability Insurance (SSDI).
A little background: The
F.I.C.A. payroll taxes that pay
Social Security Retirement
and Disability beneficiaries
go into two separate trust
funds, the Retirement Trust
Fund and the Disability Trust
Fund. They are split by a formula that has been in effect
for many years.
Because the formula does
not accurately reflect the payouts from each fund, periodically, the House of Representatives, which initiates budget
issues, must “reallocate”
funds from one trust fund to
the other in order to maintain
full payments to both groups
of beneficiaries. This is usually
a fairly routine procedure and
has been done eleven times
since 1968 with no opposition or problems, regardless
of the political party in control
of the House. Due to the age
of the allocation formula and
the shifts in types of labor, age
of workforce, and advancing
the retirement age to 67, the
reallocation of funds usually
has been from the Retirement
Fund into the Disability Fund.
If there is no reallocation
of money into the Disability
Trust Fund from the much
larger Retirement Fund, before December, 2016, SSDI
benefits will be cut 16 –
20% for the 11,000,000
disabled people currently
receiving benefits.
On the first day of the new
Congress, the new majority
adopted a “rule” about reallocation without consulting
the minority party. Instead
of simply approving the reallocation as in the past, now
a reallocation bill can only be
considered if it comes with
an accompanying proposal
which “improves the actuarial balance” of both funds.
In other words, disabled
people’s SSDI benefits will be
cut by up to 1/5 unless there
is a plan on the table to put
both Trust Funds into more
permanent solvency, i.e., a
major rewrite of the entire
Social Security retirement
and disability system.
Note that this is only a
“rule” change, not a law. So
CONTINUED ON PAGE 8
7
FROM PAGE 7
it is now in effect; neither the
Senate nor the President can
do anything to stop it.
Supporters of this new
rule have frequently tried to
portray SSDI as too easy to
get and claim almost anyone
can walk in and get it. Any
disabled person who has
gone through the application
and appeal process will have
no problem appreciating the
total inaccuracy of that.
One senator maintains
that over half the recipients
are either anxious or have a
sore back, saying, “Join the
club. Who doesn’t get up a
little anxious for work and
their back hurts.”
In 2011, the last year for
when numbers are available,
all types of mood disorders
plus all types of musculoskeletal issues comprised
less than 45% of total worker
beneficiaries, which includes
far more conditions than
anxiety and a “sore back.”
The reason for the new
rule, according to its supporters, is to push Congress
to address the inadequacy of
current revenue and benefits
payouts and stop “kicking
the can down the road.”
Those opposed to the
new rules, which include vir8
tually all of the disabled community and its advocates,
accused the House of holding the disabled hostage.
Who is correct?
While the supporters focused on anecdotes, the
Government Accounting
Office (GAO) performed an
audit of improper SSDI payments and issued its report
in 2013 (GAO13-635). It
concluded only 0.4% of
beneficiaries received overpayments, or payments for
which they were not able–not
even 1% of the total benefits
paid.
The proposed budget recently issued by The White
House specifically calls for a
reallocation into the Disability
Trust Fund, but that is only a
proposal at present.
There is a possibility that,
if pushed, the majority in the
House may postpone this
rule, however, that risks the
rule or something like it being brought up in future years
similar to other issues such
as expanding the debt limit
or threatening to cut successful, popular, and necessary programs. At present
the rule is in place, and, if
not changed or postponed,
SSDI beneficiaries will see a
large cut in their benefits by
the end of 2016.
Accountable Care
Organizations (ACOs)
One of the provisions of
the Affordable Care Act (aka
Obamacare) created ACOs
in an attempt to control the
rapidly rising medical costs.
An ACO is a group of doctors, hospitals, and other
health care providers who
come together voluntarily to
give coordinated high quality
care to their patients. This
would save costs by avoiding
unnecessary duplication of
services and prevent medical errors.
The goal of coordinated
care is to ensure that patients, especially the chronically ill such as those with
HCV and HIV, get the right
care at the right time. When
an ACO succeeds both in delivering high quality care AND
spending health care dollars
more wisely, it will share in
the savings it achieves.
This may sound a little like
the HMO model for health
care, and the goals are definitely similar in that it attempts to move away from
paying by the treatment provided (fee-for-service) and
tie payment more to health
outcomes. What separates
CONTINUED ON PAGE 9
FROM PAGE 8
an ACO from an HMO is the
patient is not locked in to any
set of providers or hospitals
where they must go for treatment. Beneficiaries can still
go to any doctor or hospital.
Under the terms of Obamacare, the ACO will be responsible for all the care needs for
a group of patients and will be
paid based on those patients’
health outcomes, satisfaction, and costs.
At present, ACOs are primarily being tried with beneficiaries who are on original,
(or fee-for-service) Medicare.
Private insurance companies
are watching closely and are
also starting to work with it on
a smaller scale. Kaiser Health
News reports that Medicare
ACOs are already serving
over one million Medicare
recipients with promising results. For an interactive map
showing current Medicare
ACOs, see the site below:
h t t p : / / w w w. c m s . g o v /
Medicare/Medicare-Fee-forService-Payment/sharedsavingsprogram/ACOs-in-YourState.html
By having the various
medical providers working
together more closely, health
outcomes will be improved,
there will be less wasted dol-
lars from duplicate and unnecessary procedures being
performed, fewer and shorter
hospital stays, and greater
patient satisfaction. The indications so far are good.
ABLE Savings Accounts
In December, 2014, Congress passed and the President signed the Achieving a
Better Life Experience (ABLE)
Act. Similar to the tax-sheltered 529 College Savings
Accounts, it allows people
with disabilities to establish
a tax-sheltered fund to assist
with expenses.
To qualify, a person must
have been diagnosed by age
26 with a disability that results in “marked and severe
functional limitations;” those
receiving Social Security disability benefits would also
qualify. Note that there is no
age limit to establishing the
fund, but diagnosis of the
condition must have occurred
while the disabled beneficiary
is age 26 or less. While this
would eliminate anyone diagnosed with HCV after age
26, it could be a significant
tool for those who are eligible.
The beneficiary, family,
and friends could set up and
fund a tax-free at financial
institutions, depositing up
to $14,000 per year. Funds
could be used for housing,
health care expenses, transportation, education, employment training, personal
support services, financial
management, and administrative services. The contributions would be with after-tax
dollars but earnings would
grow tax-free.
The maximum amount of
the fund would be the same
as each state’s maximum for
the 529 Education Tax-Free
Funds. A major advantage
is that as long as the fund
remains below $100,000,
the beneficiary would still be
eligible for Supplemental Security Income (SSI) benefits.
Regardless of the fund size,
eligibility for Medicaid would
continue.
The ABLE Fund would
have significant advantages
over the Special Needs Trust,
currently used to maintain
eligibility for needs-based
public programs. They are
much less expensive to set
up, and they do not have the
significant limitations on the
use of the funds.
For more information contact a financial planner or a
banker. States may also set
up funding plans as they do
with the Education Accounts.
9
Supplements FROM PAGE 3
• Only one supplement
consistently tested for its
labeled contents: Saw
Palmetto. The remaining
five supplements yielded
mixed results, with one
sample of garlic showing
appropriate DNA. The
other bottles yielded no
DNA from the labeled
herb.
• Of the 90 DNA test run
on 18 bottles of herbal
products purchased,
DNA matched label representation 18% of the
time.
• Contaminants identified
included allium, rice,
wheat, palm, daisy, and
dracaena (houseplant).
Walmart:
• Six “Spring Valley” brand
herbal supplements per
store were purchased
and analyzed: Gingko
Biloba, St. John’s Wort,
Ginseng, Garlic, Echinacea, and Saw Palmetto. Purchased from
three geographic locations with representative
stores in Buffalo, Utica
and Westchester.
• None of the supplements tested consis10
tently revealed DNA from
the labeled herb. One
bottle of garlic had a
minimal showing of garlic DNA, as did one bottle of Saw Palmetto. All
remaining bottles failed
to produce DNA verifying the labeled herb.
• Of the 90 DNA test run
on 18 bottles of herbal
products purchased,
DNA matched label representation 4% of the
time.
• Contaminants identified
included allium, pine,
wheat/grass, rice, mustard, citrus, dracaena
(houseplant), and cassava (tropical tree root).
http://www.hcvadvocate.
org/hepatitis/factsheets_pdf/
CAM_Complementary_
and_Alternative_Medicine_
Resources.pdf
Press Release:
A.G. Schneiderman Asks
Major Retailers To Halt
Sales Of Certain Herbal
Supplements As DNA Tests
Fail To Detect Plant Materials Listed On Majority Of
Products Tested.
h t t p : / / w w w. a g . n y.
gov/press-release/agschneiderman-asks-majorretailers-halt-sales-certainherbal-supplements-dnatests
http://www.hcvadvocate.org/hepatitis/
factsheets_pdf/CAM_
herbs_&_hepatitis_C.pdf
—Alan Franciscus, Editor-in-Chief
Abstract: Hepatitis C Virus
Antibody Positivity and Predictors Among Previously
Undiagnosed Adult Primary
Care Outpatients: CrossSectional Analysis of a Multisite Retrospective Cohort
Study—B. Smith et al.
Source: Clin Infect
Dis. 2015 Jan 16. pii: civ002.
[Epub ahead of print]
Prior to ‘Baby Boomer’
age-based testing the Centers for Disease Control and
Prevention (CDC) recommended that everyone with
specific risk factors should
be tested for hepatitis C antibodies. The current study
analyzed data between 2005
and 2010 in 4 primary care
service sites. The records
included people who had no
documented evidence of a
prior diagnosis of hepatitis C.
T h e re w e re 2 0 9 , 0 7 6
patients observed for 5
months—17,464 patients
were tested for HCV—6.4%
(1,115 people) tested as
HCV antibody positive. Factors associated with a positive HCV antibody test were
injection drug use, 19451965 birth-cohort (Baby
Boomers), and elevated ALT
enzymes. The researchers
commented that, “In these
outpatient primary settings
risk-based testing may have
missed 4 of 5 newly enrolled
patients” who were HCV antibody positive.
Editorial Comment: Agebased testing has been slow
to catch on. Hopefully, this
study will help to dispel the
naysayers and speed up the
implementation of testing.
Just imagine if we could
get all those undiagnosed
people identified and into
medical care, management
and treatment.
Abstract: Interferon therapy in hepatitis C leading to
chronic type 1 diabetes—T
Zornitzki et al.
Source: World J Gastroenterol. 2015 Jan 7;21(1):2339. doi: 10.3748/wjg.v21.
i1.233.
Interferon-based therapy
is known to exacerbate
some autoimmune diseases. A recent study reviewed
published data from 1992
to December 2013 to see if
there was a correlation between interferon treatment
and type1 diabetes.
Type 1 diabetes is an autoimmune disease—that is
the body’s immune system
attacks the pancreas and
prevents it from producing
insulin to process carbohydrates or sugars. Type
1 diabetes patients must
inject insulin to process the
sugars.
One hundred and seven
cases of type 1 diabetes
were identified. This meant
that interferon treatment
increased the risk of type
1diabetes by 10 to18-fold
compared to the general
population developing type
1 diabetes. The patients
diagnosed with type 1 diabetes required insulin therapy.
Most of the patients (105 of
107 patients) continued to
take insulin permanently (at
year 4 of follow-up).
Editorial Comment: This is
the first study that has found
an association between interferon therapy and type
1 diabetes. If people did
develop type 1 diabetes or
another autoimmune disease
during or right after treatment
and didn’t know the reason,
interferon may very well be
the cause. Thankfully, we
now have interferon-free
therapies so we don’t have
to worry about these types
of treatment-related autoimmune conditions.
11
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