<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_277"
                     title="Liver Cell Culture System Might Test New HCV Drugs (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/InfectiousDisease/Hepatitis/tb/18133?impressionId=1265819971263"
                     
      &lt;p&gt;Researchers say they can now grow liver cells that maintain their functions long enough to test potential treatments for hepatitis C.&lt;/p&gt;
&lt;p&gt;The method uses so-called &quot;micropatterned co-cultures&quot; of primary human hepatocytes and supportive stroma, according to Sangeeta N. Bhatia, MD, PhD, of MIT, and colleagues.&lt;/p&gt;
&lt;p&gt;The co-cultures were able to support the entire life cycle of hepatitis C, including infection and replication, Bhatia and colleagues reported online in the &lt;em&gt;Proceedings of the National Academy of Sciences&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Coupled with reporter systems, the co-cultures have &quot;potential as a high-throughput platform for simultaneous assessment of in vitro efficacy and toxicity&quot; of antiviral drugs, the researchers said.&lt;/p&gt;
&lt;p&gt;The lack of such a system has been a roadblock to testing potential treatments for the virus, which affects 130 million people around the world, the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;Recently, they added, researchers have been able to propagate the virus in human hepatoma cells, but those cells, among other issues, proliferate abnormally and have disturbed gene expression.&lt;/p&gt;
&lt;p&gt;To overcome those obstacles, the researchers turned to primary hepatocytes, which would make a better test system, except that they are notoriously hard to maintain in culture.&lt;/p&gt;
&lt;p&gt;To form the co-cultures, Bhatia and colleagues seeded multi-well plates with human hepatocytes, followed several hours later by murine fibroblasts.&lt;/p&gt;
&lt;p&gt;&quot;If you just put cells on a surface in an unorganized way, they lose their function very quickly,&quot; Bhatia said in a statement. &quot;If you specify which cells sit next to each other, you can extend the lifetime of the cells and help them maintain their function.&quot;&lt;/p&gt;
&lt;p&gt;In a series of experiments, Bhatia and colleagues found:&lt;ul&gt; &lt;li&gt;Pseudoparticles bearing the hepatitis C glycoproteins E1 and E2 were able to infect between 1% and 3% of the hepatocytes, but did not infect the fibroblasts.&lt;/li&gt; &lt;li&gt;A hepatitis C virus modified to express a fluorescent protein persistently replicated over a two-week period.&lt;/li&gt; &lt;li&gt;Infectious virus was found in the co-culture supernatant from four through 12 days after initial infection.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The researchers also tested some possible therapeutics, including antibodies against viral entry factors and viral protease inhibitors, and were able to show effects on replication of hepatitis C.&lt;/p&gt;
&lt;p&gt;They were also able to test two or more drugs simultaneously to show the feasibility of combination drug studies using the system.&lt;/p&gt;
&lt;p&gt;Although the system is &quot;an important step forward,&quot; Bhatia and colleagues said, the co-cultures have some limitations, including the relatively inefficient uptake of virus.&lt;/p&gt;
&lt;p&gt;But they concluded that the co-cultures have the potential to be a &quot;highly valuable system for studies of (hepatitis C) biology.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;This study had support from the Greenberg Medical Research Institute, the Ellison Medical Foundation, the Starr Foundation, the Ronald A. Shellow Memorial Fund, the Richard Salomon Family Foundation, and the NIH. The researchers said they had no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_217"
                     title="Herpes Therapy Doesn&apos;t Bar HIV Transmission (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/HIVAIDS/HIVAIDS/tb/18071?impressionId=1265819971263"
                     
      &lt;p&gt;Treating herpes has no effect on the transmission of HIV among discordant couples, researchers said.&lt;/p&gt;
&lt;p&gt;The lack of efficacy was found in a large, randomized clinical trial despite significant reductions in HIV viral load among those treated for herpes simplex-2 (HSV-2), according to Connie Celum, MD, of the University of Washington, and colleagues.&lt;/p&gt;
&lt;p&gt;Researchers will have to look for new ways to prevent transmission among discordant couples (in which one partner has HIV and the other does not), Celum and colleagues concluded online in the&lt;em&gt; New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The study comes after earlier trials also showed that treating HSV-2 with the antiviral acyclovir (Zovirax) did not lower the risk of getting HIV. (See &lt;a href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/9884&quot; mce_href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/9884&quot; target=&quot;_blank&quot;&gt;Herpes Treatment No Help in Preventing HIV&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The trials  --  and the current study  --  had their origins in epidemiological and laboratory observations that having an HSV-2 infection increased the risk of contracting HIV.&lt;/p&gt;
&lt;p&gt;Researchers reasoned that a converse effect might also be true  --  treating HSV-2 in HIV-negative people might reduce their risk of infection.&lt;/p&gt;
&lt;p&gt;The reasoning was bolstered by clinical trials showing that treating HSV-2 in HIV-positive people lowered their viral load.&lt;/p&gt;
&lt;p&gt;In the current study, that effect also occurred. HIV-positive volunteers treated with acyclovir saw, on average, a reduction in plasma concentration of HIV by 0.25 log&lt;sub&gt;10&lt;/sub&gt; copies per milliliter compared with members of the placebo group. The difference was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;But transmission among the couples was not affected, implying that a greater reduction in viral load is needed, the researchers said.&lt;/p&gt;
&lt;p&gt;The study, randomized and placebo-controlled, included 3,408 couples in Africa in which only one of the partners had HIV (but was not taking antiretroviral therapy) and also had an HSV-2 infection.&lt;/p&gt;
&lt;p&gt;The outcome was first reported at the Cape Town meeting of the International AIDS Society last year (See &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/IAS/15242&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/IAS/15242&quot; target=&quot;_blank&quot;&gt;IAS: Acyclovir Flops in Preventing HIV Transmission&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;The primary outcome was transmission between partners, verified by genetic sequencing of the virus.&lt;/p&gt;
&lt;p&gt;Transmission between partners was verified in 84 of the 132 recorded cases of transmission, the researchers said, and they were evenly divided  --  41 among those getting the drug and 43 in the placebo group.&lt;/p&gt;
&lt;p&gt;On the other hand, the use of the drug reduced the occurrence of herpes lesions by 73%, which was significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/p&gt;
&lt;p&gt;The reduction of herpes lesions suggests that the drug was being used, the researchers said, and therefore that the lack of efficacy against HIV was not a result of nonadherence to acyclovir.&lt;/p&gt;
&lt;p&gt;Overall, the rate of HIV transmission in the study was 2.7 cases per 100 person-years, markedly lower than earlier observations. The researchers attributed that to such interventions as monthly counseling on risk reduction and free condoms.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Bill and Melinda Gates Foundation, as well as the University of Washington, the National Institute of Allergy and Infectious Diseases, Gen-Probe, and the National Institute of Mental Health.&lt;/p&gt;&lt;p&gt;Celum reported financial links with GlaxoSmithKline and several other authors reported links with various pharamceutical companies.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1748"
                     title="DDW: Telaprevir Improves HCV Clearance in Resistant Patients"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/DDW/tb/14515?impressionId=1265819971263"
                     
      CHICAGO, June 3 -- The investigational protease inhibitor telaprevir, added to standard hepatitis C (HCV) treatment, produced a sustained virologic response in about half of patients who had previously failed with conventional therapy, a phase IIb trial showed.
              &lt;p&gt; 
              &lt;p&gt;Patients who received telaprevir, peginterferon, and ribavirin had higher response rates than those who received peginterferon and ribavirin alone, the current standard treatment, according to Adrian Di Bisceglie, M.D., of Saint Louis University.
              &lt;p&gt; 
              &lt;p&gt;The group of patients who received telaprevir and peginterferon, but not ribavirin had less of a benefit than those who received all three drugs, he reported at Digestive Disease Week here.
              &lt;p&gt; 
              &lt;p&gt;Because there is no existing standard of care for patients who fail to respond to standard treatment for HCV, he said, &quot;I personally believe this . . . represents a new paradigm for how we will treat nonresponders in the future.&quot;
              &lt;p&gt; 
              &lt;p&gt;About three million people in the U.S. are infected with HCV, and about half will be able to clear the virus with peginterferon and ribavirin, according to Dr. Di Bisceglie.
              &lt;p&gt; 
              &lt;p&gt;Conducted at 53 centers, the PROVE3 (Protease Inhibition for Viral Evaluation) study follows the PROVE1 and PROVE2 studies, which evaluated the effect of telaprevir in treatment-naive patients. (See &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/5444&quot; target=&quot;blank&quot;&gt;EASL: Telaprevir Shows Promise of Shortened Hepatitis C Therapy&lt;/a&gt; and &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/AASLD/7285&quot; target=&quot;blank&quot;&gt;AASLD: Telaprevir Yields Good Response in Combo Therapy for HCV&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;PROVE3 involved 453 patients with HCV genotype 1, the most common in the U.S. All had failed prior courses of treatment, either by having no virologic response, by relapsing after completing successful treatment, or by having the virus re-emerge before the end of treatment.
              &lt;p&gt; 
              &lt;p&gt;The patients were randomized to four treatment arms with varying duration of treatment with telaprevir, peginterferon, and ribavirin:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;12 weeks of all three drugs followed by 12 weeks of standard treatment
                &lt;li&gt;24 weeks of all three drugs followed by 24 weeks of standard treatment
                &lt;li&gt;24 weeks of telaprevir and peginterferon, but no ribavirin
                 &lt;li&gt;24 weeks of placebo plus standard treatment followed by 24 weeks of standard treatment (control)
                            &lt;/ul&gt;
                              &lt;p&gt; 
                              &lt;p&gt;The median age of the patients was 51 and about two-thirds were male. All four groups were well-matched according to baseline characteristics.
                              &lt;p&gt; 
                              &lt;p&gt;The primary endpoint was sustained virologic response 24 weeks after the end of each treatment regimen.
                              &lt;p&gt; 
                              &lt;p&gt;All three telaprevir groups were superior to placebo in the percentage of patients who had a sustained virologic response at follow-up:
                              &lt;p&gt; 
                              &lt;ul&gt;
                                &lt;li&gt;51% in patients who received 12 weeks of telaprevir (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)
                                &lt;li&gt;52% in those who received telaprevir for 24 weeks along with standard treatment (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001)
                                  &lt;li&gt;23% in those who did not receive ribavirin (&lt;em&gt;P&lt;/em&gt;=0.035)
                                    &lt;li&gt;14% in the controls
                                            &lt;/ul&gt;
                                              &lt;p&gt; 
                                              &lt;p&gt;Similar benefits were seen at four weeks, indicating a rapid virologic response, and immediately at the end of treatment.
                                              &lt;p&gt; 
                                              &lt;p&gt;Some patients relapsed between the end of treatment and the follow-up, 24 weeks later. The relapse rates were 30% and 13% in the two groups that received telaprevir plus standard treatment and 53% in both the group that did not receive ribavirin and the controls.
                                              &lt;p&gt; 
                                              &lt;p&gt;Notably, almost 40% of patients who had not responded to treatment at all before the study showed a sustained virologic response at follow-up in the two groups that received all three drugs (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both). That compared with only 9% of the controls.
                                              &lt;p&gt; 
                                              &lt;p&gt;Response rates of 69% and 76% were seen among prior relapsers (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), with the higher rate occurring in those who received 48 weeks of standard treatment in addition to 24 weeks of telaprevir.
                                              &lt;p&gt; 
                                              &lt;p&gt;There was no difference in response rates between patients with and without cirrhosis.
                                              &lt;p&gt; 
                                              &lt;p&gt;&quot;It appears that telaprevir is able to overcome this and other traditional poor response factors,&quot; Dr. Di Bisceglie said.
                                              &lt;p&gt; 
                                              &lt;p&gt;The most common adverse events in groups receiving telaprevir were fatigue, nausea, headache, rash, itching, anemia, and gastrointestinal side effects, only some of which were severe enough to result in discontinuation.
                                              &lt;p&gt; 
                                              &lt;p&gt;The dosing regimen involving 24 weeks of all three drugs, followed by 24 weeks of peginterferon and ribavirin, is currently being evaluated in a phase III trial dubbed REALIZE.
                                              &lt;p&gt; 
                                              &lt;p&gt;Dr. Di Bisceglie said FDA approval for telaprevir is about two years away. Telaprevir and a similar drug, boceprevir, appear to be the closest to approval.
                                              &lt;p&gt; 
                                              &lt;p&gt;Patients with significant liver disease should receive treatment with peginterferon and ribavirin right away, he said, but patients who have previously failed a course of treatment might think about waiting for these drugs to hit the market.
                                              &lt;p&gt; 
                                              &lt;p&gt;&quot;These drugs are coming and not that far away, and it may be better to be waiting with our nonresponders for better treatment,&quot; he said.
                                              &lt;p&gt; 
                                              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by Tibotec and Vertex Pharmaceuticals, co-developers of telaprevir.
                                              &lt;p&gt; 
                                              &lt;p&gt;Dr. Di Bisceglie reported no conflicts of interest.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
                                             
    </recommendedItem>
    <recommendedItem id="20090101_19_3460"
                     title="ACG: HCV Drives Down Kidney Function (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ACG/tb/16690?impressionId=1265819971263"
                     
      &lt;p&gt;SAN DIEGO  --  Hepatitis C infection almost doubles the risk of chronic kidney disease and significantly increases progression to end-stage renal disease, according to data reported here.&lt;/p&gt;
&lt;p&gt;The association remained significant regardless of whether chronic kidney disease was defined in terms of creatinine clearance, proteinuria, glomerular filtration rate (GFR), or a combination of the parameters, according to Sanjaya Satapathy, MD, of the Mayo Clinic in Rochester, Minn., and colleagues.&lt;/p&gt;
&lt;p&gt;The disparity between patients who have HCV infection and those who don&apos;t increased with age, reaching a five-fold difference in the prevalence of chronic kidney disease in patients older than 70, Satapathy said in a presentation at the American College of Gastroenterology meeting.&lt;/p&gt;
&lt;p&gt;&quot;There is a higher prevalence of chronic kidney disease and proteinuria in patients with hepatitis C infection,&quot; he said. &quot;Baseline viral load is higher in patients with chronic kidney disease and is an independent positive predictor for chronic kidney disease.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Progression to chronic kidney disease and end-stage renal disease is more rapid in patients with HCV infection,&quot; he added. &quot;Progression to chronic kidney disease is independent of diabetes.&quot;&lt;/p&gt;
&lt;p&gt;&quot;We conclude that hepatitis C is associated with the development of chronic kidney disease and poorer renal survival.&quot;&lt;/p&gt;
&lt;p&gt;Several lines of evidence have linked HCV infection and kidney disease. HCV has been reported to cause glomerular disease, increase the risk of albuminuria, and accelerate progression of diabetic nephropathy. Additionally, HCV particles or antigens have been identified in glomeruli and tubules, said Satapathy. However, data on the association have been inconsistent.&lt;/p&gt;
&lt;p&gt;Satapathy and his colleagues hypothesized that HCV increases the risk of chronic kidney disease and accelerates its progression.&lt;/p&gt;
&lt;p&gt;To test the hypothesis they performed a retrospective analysis of medical records on HCV-positive patients seen between January 2003 and October 2006 in a gastroenterology clinic. Patient data were traced back to June 1, 1999 or the date of first visit.&lt;/p&gt;
&lt;p&gt;The chart review yielded 552 patients who tested positive for anti-HCV antibodies. They were matched with a 313-patient, non-HCV, control group.&lt;/p&gt;
&lt;p&gt;Satapathy and colleagues used two sets of criteria to define chronic kidney disease.&lt;/p&gt;
&lt;p&gt;One definition stipulated persistence of proteinuria and/or serum creatinine &amp;gt;1.5 mg/dL in men or &amp;gt;1.3 mg/dL in women for more than three months.&lt;/p&gt;
&lt;p&gt;The second definition conformed to the National Kidney Foundation (NKF) guidelines that include structural or functional evidence of kidney damage for three months or GFR &amp;lt;60mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; for three months with or without evidence of kidney damage.&lt;/p&gt;
&lt;p&gt;Proteinuria was defined as &amp;#8805;30 mg/dL by dipstick measurement, and investigators used three months as the cutoff between intermittent and persistent proteinuria.&lt;/p&gt;
&lt;p&gt;The HCV and control groups did not differ with respect to baseline characteristics, with the exception of a higher prevalence of HIV infection (7.6% versus 1.3%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0005) and positive history of injection drug use (23.2% versus 1.9%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0005) in the HCV group.&lt;/p&gt;
&lt;p&gt;At baseline, 3.3% of the HCV group and 3.2% of the control group had chronic kidney disease, as defined by NKF criteria.&lt;/p&gt;
&lt;p&gt;At follow-up, the prevalence had increased to 8.3% in the HCV-positive group compared with 4.5% of the control group (&lt;em&gt;P&lt;/em&gt;=0.032).&lt;/p&gt;
&lt;p&gt;Combining proteinuria with GFR resulted in a prevalence of 9.6% in the HCV group and 5.1% in the control group (&lt;em&gt;P&lt;/em&gt;=0.019).&lt;/p&gt;
&lt;p&gt;When chronic kidney disease was defined by serum creatinine level, 6.7% of the HCV group and 3.5% of the control group had chronic kidney disease (&lt;em&gt;P&lt;/em&gt;=0.049).&lt;/p&gt;
&lt;p&gt;Adding proteinuria to serum creatinine resulted in rates of 7.8% and 4.2% in the HCV and control groups, respectively (&lt;em&gt;P&lt;/em&gt;=0.037).&lt;/p&gt;
&lt;p&gt;Analysis of the data by age groups, showed that 1% to 2% of patients younger than 40 had chronic kidney disease in both the control and HCV groups.&lt;/p&gt;
&lt;p&gt;With increasing age, more patients in the HCV group had chronic kidney disease compared with the control group, although none of the differences was statistically significant: &lt;ul&gt; &lt;li&gt;40 to 49, 4.6% versus 3%&lt;/li&gt; &lt;li&gt;50 to 59, 9.8% versus 5.2%&lt;/li&gt; &lt;li&gt;60 to 69, 22.7% versus 10.9% (&lt;em&gt;P&lt;/em&gt;=0.083)&lt;/li&gt; &lt;li&gt;&amp;gt;70, 40% versus 8.3% (&lt;em&gt;P&lt;/em&gt;=0.054)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Rates of intermittent proteinuria were similar between the groups, but HCV patients had a significantly greater rate of persistent proteinuria (6.8% versus 2.9%, &lt;em&gt;P&lt;/em&gt;=0.024).&lt;/p&gt;
&lt;p&gt;HCV had a significant adverse effect on kidney survival compared with the control group, whether defined by onset of chronic kidney disease (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0005) or time to end-stage renal disease (&lt;em&gt;P&lt;/em&gt;=0.005). HCV infection had a similar adverse effect on renal survival in patients with and without diabetes.&lt;/p&gt;
&lt;p&gt;Satapathy reported that HCV patients who developed CKD had significantly higher baseline viral loads (&lt;em&gt;P&lt;/em&gt;=0.006).&lt;/p&gt;
&lt;p&gt;A similar relationship was observed in a second, smaller study reported at the meeting. That study involved 19 HCV-positive patients who had a persistently elevated viral load (&amp;gt;1 million copies/mL) during follow-up for more than 1.5 years and 17 HCV patients who had a persistently low viral load (&amp;lt;10,000 copies/mL) during follow-up.&lt;/p&gt;
&lt;p&gt;At the beginning of follow-up, patients in the two groups had similar kidney function (GFR 110 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; in patients with a high viral load and 96 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; in the patients with a low viral load), said Fadi Rzouq, MD, of the University of Washington in Seattle.&lt;/p&gt;
&lt;p&gt;During 2.6 years of follow-up during which time none of the patients received treatment for HCV, mean GFR decreased by 27.6 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; in patients with a persistently elevated viral load, whereas GFR declined by &amp;lt;0.2 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; during 1.9 years of follow-up in the patients who had a persistently low viral load (&lt;em&gt;P&lt;/em&gt;=0.003).&lt;/p&gt;
&lt;p&gt;The results &quot;point toward the possibility of a direct renal toxicity induced by HCV, although this conclusion needs to be confirmed by more studies,&quot; said Rzouq.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Satapathy and co-investigators reported no disclosures.&lt;/p&gt;&lt;p&gt;Rzouq reported no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3475"
                     title="ASN: HCV Changes Dialysis Treatment Needs (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASN/tb/16712?impressionId=1265819971263"
                     
      &lt;p&gt;SAN DIEGO  --  Patients on dialysis need less epoetin to treat their anemia if they are infected with hepatitis C (HCV), a researcher reported here.&lt;/p&gt;
&lt;p&gt;HCV-positive patients also needed a lower dose of IV iron than their noninfected counterparts, even though they had similar hemoglobin levels, according to David Goodkin, MD, of the Arbor Research Collaborative for Health in Ann Arbor, Mich.&lt;/p&gt;
&lt;p&gt;This is a &quot;surprising, unusual finding,&quot; Goodkin said at the American Society of Nephrology meeting, because most inflammatory diseases, which interfere with the signal the bone marrow sends to make more red blood cells, would result in the need for a higher dose of epoetin.&lt;/p&gt;
&lt;p&gt;&quot;We speculate that it may be that this viral infection is actually stimulating the liver to make this hormone erythropoietin,&quot; Goodkin said, although he admitted that he doesn&apos;t know why the virus would activate the erythropoietin-producing cells.&lt;/p&gt;
&lt;p&gt;He said the finding would probably not affect clinical practice because patients on dialysis have their epoetin doses adjusted regularly anyway.&lt;/p&gt;
&lt;p&gt;&quot;The doctors are still going to follow the hemoglobin level and adjust the EPO dose,&quot; Goodkin said. &quot;This is just a clue that if it&apos;s hepatitis C-positive, they&apos;ll need less EPO, on average, than people who are hepatitis C-negative.&quot;&lt;/p&gt;
&lt;p&gt;Goodkin said he decided to investigate after he saw the results of a small case-control study from 2008, involving 66 patients, showing that those on dialysis who were infected with HCV needed significantly lower doses of erythropoietin (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). There was also a trend toward lower IV iron requirements (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.07).&lt;/p&gt;
&lt;p&gt;To explore the issue on a larger scale, he turned to the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS).&lt;/p&gt;
&lt;p&gt;The current analysis included 36,245 patients in 12 countries who were on hemodialysis, 7.8% of whom were positive for HCV.&lt;/p&gt;
&lt;p&gt;After adjusting for age, sex, race, years of hemodialysis, country, and 14 comorbidities, he and his colleagues found that the weekly epoetin dose was significantly lower in the HCV-positive patients (7,737 versus 8,210 Units, &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;IV iron dose was also significantly lower in the infected patients (89.2 versus 96.4 mg/month, &lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;Hemoglobin concentration was not significantly different in the two groups (&lt;em&gt;P&lt;/em&gt;=0.46).&lt;/p&gt;
&lt;p&gt;The odds ratios for not receiving epoetin or IV iron therapy among HCV-positive patients were 1.15 (&lt;em&gt;P&lt;/em&gt;=0.002) and 1.19 (&lt;em&gt;P&lt;/em&gt;=0.0002), respectively.&lt;/p&gt;
&lt;p&gt;Hepatitis B infection, on the other hand, offered no advantage.&lt;/p&gt;
&lt;p&gt;In addition to the unexpected effect of HCV infection on the epoetin dose, another surprising finding was that only seven infected patients in the study received antiviral treatment, including interferon.&lt;/p&gt;
&lt;p&gt;Goodkin speculated that clinicians might have been sparing the patients the adverse effects of antiviral therapy because most HCV-positive patients do not develop cirrhosis and liver failure, and patients on dialysis, many of whom are older, have a limited lifespan.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;DOPPS is funded by Amgen, Kyowa Hakko Kirin, and Genzyme.&lt;/p&gt;&lt;p&gt;Goodkin reported relationships with Affymax, AMAG Pharmaceuticals, Amgen, FibroGen, Keryx, Seattle Life Sciences, Xenon Pharmaceuticals, and Urodynamix Technologies.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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