Hepatitis C-Positive Organs for Liver and Kidney Transplantation —Emerging Data and Current Management Strategies
AbstractPurpose of ReviewWe aim to review the current guidelines and emerging data and compare the pros and cons for the use of HCV-positive organs.Recent FindingsSome recent data suggests that the use of HCV-positive livers and kidneys safely increases the organ pool, additionally reducing wait list time, healthcare costs, and mortality.SummaryDespite this therapeutic breakthrough, the demand for organs and waitlist mortality remains high. Every year, thousands of viable hepatitis C-positive organs are discarded. The emerging data regarding transplantation of HCV-positive organs is promising; however, further research is ...
Source: Current Hepatitis Reports - May 17, 2019 Category: Infectious Diseases Source Type: research
State of the Art HCV Treatment in Children
AbstractPurpose of ReviewHepatitis C infection is a global issue with an estimated 5 million children with active HCV infection worldwide. The advent of oral direct-acting antiviral (DAA) regimens has revolutionized treatment in adults with excellent efficacy and tolerability. There are limited data and few approved therapies in children. The aim of this review is to discuss the currently approved regimens for children and the recently reported results of clinical trials of DAA in children.Recent FindingsDAA regimens are currently approved only for children ≥ 12 years. For most children< 12 years, it is recomme...
Source: Current Hepatitis Reports - May 16, 2019 Category: Infectious Diseases Source Type: research
The Role of Hepatic and Splanchnic Lymphatic System in Portal Hypertension and Ascites
AbstractPurpose of ReviewThe lymphatic network plays a major role in maintaining tissue fluid homeostasis. Therefore, several pathological conditions associated with edema formation result in deficient lymphatic function. However, traditionally, the lymphatic system has been underestimated until recent years when it has been noticed the importance of this system in chronic liver disease. This review highlights the knowledge of lymphatic biology in the context of portal hypertension and liver cirrhosis.Recent FindingsAmong different roles of lymphatic system in liver disease, two remarkable ones are the contribution in asci...
Source: Current Hepatitis Reports - May 15, 2019 Category: Infectious Diseases Source Type: research
Portal Hypertension in NASH: Is It Different from Other Aetiologies?
AbstractPurpose of ReviewIn non-alcoholic fatty liver disease (NAFLD), an increased portal pressure is observed before signs of cirrhosis or even inflammation or fibrosis are histologically present. This review describes the differences between the mechanisms of cirrhotic portal hypertension (PHT) and PHT in non-cirrhotic NAFLD.Recent FindingsThe increased portal pressure in NAFLD is primarily a result of an increased intrahepatic vascular resistance. Vasodilation is decreased by endothelial dysfunction and the sensitivity to vasoconstrictors is increased. Furthermore, the activation of hepatic stellate cells and the prese...
Source: Current Hepatitis Reports - May 13, 2019 Category: Infectious Diseases Source Type: research
Prediction of Decompensation in Patients with Compensated Cirrhosis: Does Etiology Matter?
AbstractPurpose of ReviewTransition from compensated to decompensated cirrhosis, defined by overt clinical signs, represents a turning point in the clinical course of the disease. In fact, while compensated cirrhosis is a silent disease characterized by long survival, decompensated cirrhosis is associated with symptoms markedly reducing the quality of life and with a median survival of 2 –4 years. Therefore, identifying predictors of decompensation and investigating potential interventions for its prevention is a major objective. Mechanisms and incidence of decompensation, together with its predictors, are summarized he...
Source: Current Hepatitis Reports - May 9, 2019 Category: Infectious Diseases Source Type: research
Non-invasive Fibrosis Assessment of Patients with Hepatitis C: Application of Society Guidelines to Clinical Practice
AbstractPurpose of ReviewChronic hepatitis C (CHC) infection remains a significant global public health burden and is associated with significant morbidity and mortality due to complications of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). All oral direct-acting antivirals (DAAs) are associated with high rates of sustained virologic response (SVR). Pre-treatment assessment for liver fibrosis remains of high importance as it may impact treatment choice, treatment duration, and signal the presence of cirrhosis for which variceal screening and HCC surveillance are warranted.Recent FindingsNon-invasive fibrosis...
Source: Current Hepatitis Reports - May 8, 2019 Category: Infectious Diseases Source Type: research
Testing for Hepatitis C in Pregnancy: the Time Has Come for Routine Rather than Risk-Based
AbstractPurpose of ReviewThe purpose of this review is to discuss the reasons for HCV testing during pregnancy and to review what is known about antiviral treatment during pregnancy.Recent FindingsHepatitis C virus affects over 3 million persons in the USA and is one of the leading infectious causes of death. While HCV is most commonly transmitted via parenteral exposures, thus affecting people who inject drugs, it is also transmitted from mother-to-child. Due to an expanding opioid crisis, an increasing number of women of childbearing age are now infected, resulting in transmission to infants. Risk-based screening has nev...
Source: Current Hepatitis Reports - May 8, 2019 Category: Infectious Diseases Source Type: research
HCV Management in the Incarcerated Population: How Do We Deliver on This Important Front?
AbstractPurpose of ReviewIn this review, the peculiarities of infection and treatment of HCV in the prison population are detailed. In addition, the barriers to HCV treatment and possible solutions are highlighted.Recent FindingsSeveral previous experiences of HCV treatment in prisons have been successful. In this manuscript, we detail the most relevant.SummaryWe think that incarceration should be considered an opportunity to engage this population in health care. Therefore, we should encourage systematic screening of these patients and promote the access to treatment by supporting equity with the general population. Thus,...
Source: Current Hepatitis Reports - May 1, 2019 Category: Infectious Diseases Source Type: research
Hepatic Venous Pressure Gradient Response in Non-Selective Beta-Blocker Treatment —Is It Worth Measuring?
AbstractPurpose of ReviewTo review the evidence supporting the assessment of hepatic venous pressure gradient (HVPG) response to non-selective beta-blockers (NSBB).Recent FindingsHVPG response to NSBB reduces the risks of variceal bleeding, hepatic decompensation due to ascites and its complications, and, finally, mortality. In hemodynamic non-responders to NSBB, their effectiveness is suboptimal, although there is increasing evidence for non-hemodynamic effects. Carvedilol may be a good treatment option for patients with non-response to conventional NSBB, as it is more potent in decreasing HVPG. Furthermore, hemodynamic n...
Source: Current Hepatitis Reports - May 1, 2019 Category: Infectious Diseases Source Type: research
The Use of Grafts from HCV+ Patients in Transplantation: Are we There Yet?
AbstractUse of organs from donors previously or currently infected with hepatitis C virus is gaining interest in the transplantation realm.Purpose of ReviewHere we will outline the historical perspectives for discarding such organs, review the reasons for revitalized interest in their use, and highlight available data on the use of hepatitis C virus (HCV)-viremic grafts in transplantation. We will summarize arguments supporting and against such practices and offer our recommendations.Recent FindingsHCV can now be safely and effectively treated post transplantation with direct-acting antivirals (DAAs). Several reports are h...
Source: Current Hepatitis Reports - May 1, 2019 Category: Infectious Diseases Source Type: research
Patient Selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Associated Conditions
AbstractPurpose of ReviewThis review summarizes the key developments and latest evidence for transjugular intrahepatic portosystemic shunt (TIPS) for the indications of refractory ascites and related conditions, as well as factors that should be taken into consideration with regard to patient selection.Recent FindingsRecent evidence from randomized controlled studies has suggested that the early institution of TIPS in well-selected patients with refractory ascites may confer a survival benefit. Increasing evidence is also mounting on the potential role of TIPS in improving and reversing hepatorenal syndrome.SummaryTIPS has...
Source: Current Hepatitis Reports - May 1, 2019 Category: Infectious Diseases Source Type: research
Acute HCV Treatment: What Should We Do in the DAA Era?
AbstractPurpose of ReviewAcute hepatitis C infection is a growing concern in the USA, especially in light of the opioid epidemic. Prior treatment data consisted of trials in patients receiving interferon-based regimens. There is now emerging evidence regarding the safety and efficacy of direct-acting antivirals for the treatment of acute hepatitis C. This review summarizes the current evidence on the treatment of acute HCV in the DAA era.Recent FindingsCertain populations, such as people who inject drugs, or HIV-positive men who have sex with men, may benefit from early treatment of acute HCV. As compared with chronic hepa...
Source: Current Hepatitis Reports - May 1, 2019 Category: Infectious Diseases Source Type: research
Novel Targets and Drug Development in Portal Hypertension
AbstractPurpose of the ReviewThis review aims to introduce animal models of portal hypertension in which targets and drugs can be tested and presents current advances in the field of preclinical and early clinical settings.Recent FindingsThe interest in this field has risen in recent years and many promising targets and potential drugs have been tested in preclinical and early clinical studies. Most of these targets are intrahepatic and aim to decrease hepatic stellate cell activity, as this cell type mediates both fibrosis and portal hypertension.SummaryLiver cirrhosis with portal hypertension is a global health burden du...
Source: Current Hepatitis Reports - April 29, 2019 Category: Infectious Diseases Source Type: research
HVPG Measurements as a Surrogate of Clinical Events in Cirrhosis: Experience from Clinical Trials
AbstractPurpose of ReviewUpdate current knowledge of the use of hepatic venous pressure gradient (HVPG) as a predictor of clinical events and of efficacy of therapy for portal hypertension.Recent FindingsHVPG is a good predictor of clinical events. Decrease in HVPG during therapy is accompanied by a decreased incidence of complications from portal hypertension and improved survival.SummaryHVPG measurements are a valuable tool in the management of portal hypertension in cirrhosis. In addition of detecting and grading the severity of portal hypertension, HVPG measurements provide robust prognostic information on the risk of ...
Source: Current Hepatitis Reports - April 29, 2019 Category: Infectious Diseases Source Type: research
HCV Exposure in the Health Care Arena. Is there a Role for Post-exposure Prophylaxis?
AbstractPurpose of ReviewHealthcare workers are a vulnerable population for exposure to a variety of bloodborne pathogens including hepatitis C (HCV). With the development of novel efficacious treatments for chronic HCV, the role of post-exposure prophylaxis (PEP) has been suggested instead of the current approach to monitor for the development of infection.Recent FindingsThe lack of robust studies that HCV PEP lowers transmission risk as well as the significant financial cost limits enthusiasm for routine use of HCV PEP at this time.SummaryWe support stringent monitoring protocols with prompt referral for evaluation and t...
Source: Current Hepatitis Reports - April 26, 2019 Category: Infectious Diseases Source Type: research
