Matt's Blog

The Problem With Selling Organs
Yesterday morning Francis Delmonico, the Director of Medical Affairs for the
Transplant Society and an advisory to the WHO Transplant Committee, phoned me
because he had seen some of the articles I have been writing on the kidney
racket here in Chennai on this blog and in Wired News. He had included several
of my posts on the subject at a recent convention of nephrologists in Rio last
week and wanted to know more about the information I had gathered in my three
months researching the subject.
What strikes me most about the paying for organs issue is that the conversation
is still very narrowly defined. In the comments sections of other blogs I have
been accused of not truly understanding the situation and sensationalizing
medical procedures that ultimately aim to benefit both the donor (with cash) and
a patient who has to endure a painful existence on dialysis. Many people believe
that what is happening in Chennai is basically a well maintained free-market
that is ultimately tailored to the needs of patients. The assumption that many
people make is that the trade should be made legal.
But what I have seen in case after case on the streets of this city is that
everyone--doctors, brokers, news people, administrators, NGO workers and
dialysis patients--are exclusively focused on the plight of the patients paying
for an organ. They don't seem concerned in the least for people who supposedly
willingly sold their flesh to an underworld gang.
The truth on the streets of Chennai--and the world at large--is that the trade
in human organs is organized by a criminal underground that systematically
cheats and mishandles donor and patient interests. The people who sell their
kidneys get no good aftercare and often develop health problems as a result of
their surgery. Brokers and doctors them off out of the majority of the income
from the procedure and once they have left the hospital premises they are no
better off then when they signed up for the surgery. No one escapes poverty from
selling an organ. In Chennai, organ brokers pay between 30,000 and 60,000
($700-$1500) for a kidney. A patient will pay between 300,000 and 600,000 rupees
($7,000-$14,000) for the surgery. The rest of the money gets divvied up between
the broker, the doctor, official bribes, and hospital administrators).
One woman I met recently named Mallika (see photo) was paid on the low end for
her kidney. She made $700 and had to stay in a hospital for three weeks for
testing. The broker absconded with the cash that he made. Then, two weeks ago,
her 16 year old son was diagnosed with an advanced case of jaundice that caused
his kidneys to fail. At the moment he is at Stanley hospital getting dialysis
treatments but it is unlikely that she will be able to afford the treatment for
long. In a month he will die.
Mallika's case illustraites the inherent inequality of the system. She's poor
and a member of the city's organ farm. While she has been a health care provider
to a wealthy Indian patient, she has no access to care for her son. She can't
donate an organ to her son to save his life because the underworld has already
stolen the only commodity that she had access to.
According to the WHO for the last decade China has executed 5000 prisoners
annually in order to harvest organs. The organs they provide account for upwards
of 11,000 heart, liver and kidney transplants. Can you imagine being a prisoner
in China knowing that your only value to the government is to be a host for
organs? It is sort of like being a live fish in a tank at a sushi restaurant.
And while the Health Minister has vowed to end the practice (on behalf of the
upcoming Olympics) it most likely continues to today.
But what happens if China does cut off this steady supply of transplant organs?
There will still be a market for them and somehow wealthy sick people will
engage brokers and organized criminals to provide them. They will come from
people like Mallika.
In my opinion, in an article that will be published in Wired News this week or
next, I argue that the only way to solve the problem is to drive the price of
organs down by increasing the supply of cadaver organs. And the only way to do
that is to harvest organs from every possible brain dead organ donor without
regard to consent. The technology is in place to make it possible to harvest
organs from you, me and anyone else who gets killed in an auto accident. Organs
can be flown around the world in less than 24 hours and transplants made
available to anyone at a fraction of the live-donor costs. But the sad state of
the present is that live-donor transplants are logistically easier to manage.
The donor can find their own way to the hospital and the negotiations only
involve one person (rather than a whole family for a brain-dead organ).
Inevitably, efforts to regulate the organ market just don't work. In places like
Iran and the Phillipines where selling organs is basically legal you find that
the state has taken over the role of brokers and rarely looks out for the
welfare of patients. And even if one country regulates the trade in transparent
way, it will most likely be more expensive than unregulated--illegal
markets--and patients will seek shady transplants abroad.
So when this article appears in a couple days on Wired News, I expect that
dozens of people will levy the charge at me that I just don't understand the
free market. That I'm sensationalizing the stories of donors and not adequately
looking at the levels of despair of a person on dialysis. To this, I can only
think about the countless conversations I have had with people who have given
their organs, been cheated, and are worse off than they were before.
In the words of Nancy Schper-Hughes, the founder of Organs Watch, "Why should
the poor have to pay the body tax?"
click here to see other photos from my thee month investigation.
http://www.scottcarneyonline.com/blog/2007/05/problem-with-selling-organs.html

HCMC hospital good for liver transplants: Belgian doctors
Ho Chi Minh City's Pediatrics Hospital 2 is ready to perform liver
transplants, according to Belgian doctors who surveyed the hospital's technical
and medical standards last week.
After checking postoperative results of the three patients who have had
liver transplants there over the past two years, the delegation of Belgian
doctors announced that biopsy results and other medical examinations showed that
the patients were doing well with the replaced livers performing their functions
effectively.
Given this international nod, the hospital, located at 14 Ly Tu Trong
Street in District 1, will conduct its fourth liver transplant in early July on
a 10-year child.
Reported by Thanh Tung - Translated by Minh Phat
http://www.thanhniennews.com/healthy/?catid=8&newsid=27604

15-year-old Brandon Brewer in surgery today
La Vergne teen Brandon Brewer is in surgery this morning at Children's
Hospital of Pittsburgh where a failed transplanted small bowel is being removed.
"They came and got him about 7:30" this morning, his mother, Brande
Brewer, said in a phone call at around 9:30 a.m. today from the hospital. "The
surgery will last at least eight hours, could be up to 12.
"He was scared, but he was very, very brave," Brewer said. "I am very
proud of him for being so brave."
After the surgery, Brandon "will be in intensive care three to five days,
if not longer," she added.
The 15-year-old took his first flight to Pittsburgh via air ambulance 11
years ago to receive the original small bowel transplant. At the time, that
organ allowed him to absorb nutrients from food. Prior to the transplant, he had
been unable to get his nourishment without tube feedings because of a rare
genetic condition, Hirschsprung's disease. But the tube feedings he endured to
survive were destroying his liver.
Brandon's first transplant allowed his liver to be saved at that time, but
during today's surgery, a biopsy will be done of his liver to see if it has now
been damaged to the point that he will also need a transplant for it.
After the original small bowel transplant at age 4, Brandon was able to
eat normally, attend public school and even play youth league baseball. But as
the years have gone by, his body began to reject the transplanted organ.
After today's surgery, Brandon should qualify for a new transplant in
three to six months, his mother said.
Brandon needs the community's prayers, his mother said today.
A trust fund has been set up for the Brewer family to cover the high
medical expenses. Donations can be made to First Tennessee Bank, c/o Christopher
Brandon Brewer, 770 Nissan Drive, Smyrna, TN 37167.
To learn more about Brandon and follow his mother's journal of their
experiences, log on to www.caringbridge.org. Click on "visit a CaringBridge
site" and then type in brandonbrewer.
http://dnj.midsouthnews.com/apps/pbcs.dll/article?AID=/20070501/LIFESTYLE/705010\
04

Contact: Amy Molnar
amolnar@...
John Wiley & Sons, Inc.
Racial disparities in treatment of patients with cirrhosis and complications of
portal hypertension
African-American and Hispanic patients receive less palliative and lifesaving
treatment
African-American and Hispanic patients hospitalized for complications of portal
hypertension were less likely to undergo a palliative shunt, prompt endoscopy,
or liver transplantation compared to white patients, according to a new study in
the May issue of Hepatology, a journal published by John Wiley & Sons on behalf
of the American Association for the Study of Liver Diseases (AASLD). The article
is also available online via Wiley Interscience
(http://www.interscience.wiley.com/journal/hepatology).
Liver disease is very common in the United States and as it progresses, patients
develop portal hypertension-related complications, such as variceal bleeding,
ascites or hepatic encephalopathy. These patients should be considered for liver
transplantation, without which they face a 2-year survival prognosis of less
than 50 percent. While awaiting transplants, they may be candidates for
palliative procedures including endoscopic band ligation or portosystemic
shunts.
Previous studies have revealed widespread racial disparities in disease
treatments and outcomes. To determine the influence of race and health insurance
for patients with serious liver disease, including their likelihood of receiving
palliative procedures or transplants, researchers, led by Paul J. Thuluvath. MD
(and Geoffrey Nguyen, Fellow in Gastroenterology & Hepatology) of Johns Hopkins
University School of Medicine examined a nationally representative,
population-based sample of hospitalized patients with cirrhosis and
complications of portal hypertension.
Using the Nationwide Inpatient Sample, the researchers included 63,696 patients
with cirrhosis who were admitted to a hospital between 1998 and 2003 for a
complication of portal hypertension. The researchers gathered demographic data,
information on health insurance and treatment efforts, and then performed
statistical analyses, adjusting for potential confounding factors. They found
that during hospital stays, African-American and Hispanic patients were
significantly less likely than white patients to receive a portosystemic shunt,
a prompt endoscopic variceal hemostasis, or a liver transplant.
Compared to white patients, the odds ratio of undergoing portosystemic shunt for
was .37 for African-Americans, and .69 for Hispanics. Similarly, the odds ratio
of undergoing liver transplantation was .32 for African-Americans and .46 for
Hispanics. For patients with variceal bleeding, rates of upper endoscopy and
variceal treatment were similar, however, the odds ratio of delayed endoscopy
(more than 24 hours after admission) was 1.6 for African-American patients,
compared to white patients. African-American patients were more likely to die in
the hospital compared to white patients, while Hispanic patients were less
likely than white patients to die in the hospital.
Relative to those who had private insurance, patients receiving Medicare,
Medicaid or who were uninsured were less likely to undergo a shunt procedure,
more likely to have a delayed endoscopy, and much less likely to receive a liver
transplant.
"We have shown that there are striking racial variations in surgical and
endoscopic procedures used in the inpatient management of complications of
portal hypertension in the USA," the authors report. "The reasons for these
racial differences are unclear from this study."
While non-medical factors such as health care access may play a contributing
role, the authors also found that racial differences were independent of type of
health insurance. They suggest that disease severity, for which they were unable
to control, might also play a role.
"Further primary studies are warranted to confirm and elucidate the mechanisms
of racial disparities in order to enact interventions to rectify them," the
authors conclude. "Concurrently, it is a measure of good practice and quality of
care to develop more standardized protocols in the management of portal
hypertension to ensure equitable care regardless of race, health insurance
coverage, or socioeconomic status."
###
Article: "Racial Disparities in the Management of Hospitalized Patients with
Cirrhosis and Complications of Portal Hypertension: A National Study" Nguyen,
Geoffrey; Segev, Dorry; Thuluvath, Paul. Hepatology; May 2007; (DOI:
10.1002/hep.21580).
http://www.eurekalert.org/pub_releases/2007-05/jws-rdi050107.php

NIH FUNDS CENTER IN IOWA TO STUDY BOTANICALS USED IN DIETARY SUPPLEMENTS
U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH
NIH News
Office of the Director (OD)
<http://www.nih.gov/icd/od/
Office of Dietary Supplements (ODS)
<http://ods.od.nih.gov/
National Center for Complementary and Alternative Medicine (NCCAM)
<http://nccam.nih.gov/
FOR IMMEDIATE RELEASE: Thursday, May 3, 2007
CONTACT: Kelli Marciel, 301-496-4819, <e-mail: marcielk@...
NIH FUNDS CENTER IN IOWA TO STUDY BOTANICALS USED IN DIETARY SUPPLEMENTS
The Office of Dietary Supplements (ODS), a component of the National Institutes
of Health (NIH), today announced a grant to Iowa State University to study
botanicals used as ingredients in dietary supplements. A multidisciplinary
research team will study Hypericum (St. John's wort), Prunella (Self-heal), and
several types of Echinacea (for example, Purple Coneflower) for their anti-viral
and anti-inflammatory properties. The center will be headed by Dr. Diane Birt,
Distinguished Professor at Iowa State University, and will bring together
researchers from ISU, the University of Iowa and Yale University.
"The work of all of the NIH-sponsored botanical research centers has proven to
be important in advancing science in this area. We expect that this center at
Iowa State University and the University of Iowa will continue to provide new
insights into factors that can influence levels of bioactive components in
plants and thereby modify the biological effects of botanicals used in dietary
supplements," said Paul Coates, Ph.D., Director of ODS.
NIH currently funds six dietary supplement research centers focused on
botanicals. Scientists within these centers emphasize basic and preclinical
research of potential benefit to human health. The studies at ISU will focus on
identifying compounds and chemical profiles for anti-viral and anti-inflammatory
activities and complement research at other centers that are studying the
botanicals and inflammation. In recent years, inflammation has been identified
as a common denominator of a number of chronic diseases, such as heart disease.
The National Center for Complementary and Alternative Medicine (NCCAM) at NIH
will co-fund the Iowa center. "Given that millions of Americans are using
natural products, this research center will join several other NIH-funded
botanical centers in conducting key research to determine whether and by what
mechanisms botanicals may serve as effective treatments or preventive
approaches," said Ruth L. Kirschstein, M.D., Acting Director of NCCAM.
The Office of the Director, the central office at NIH, is responsible for
setting policy for NIH, which includes 27 Institutes and Centers. This involves
planning, managing, and coordinating the programs and activities of all NIH
components. The Office of the Director also includes program offices which are
responsible for stimulating specific areas of research throughout NIH.
Additional information is available at <http://www.nih.gov/icd/od/
The Office of Dietary Supplements was established in 1995 as a result of the
Dietary Supplement Health and Education Act. The mission of ODS is to strengthen
knowledge and understanding of dietary supplements by evaluating scientific
information, stimulating and supporting research, disseminating research
results, and educating the public to foster an enhanced quality of life and
health for the U.S. population.
The mission of the National Center for Complementary and Alternative Medicine is
to explore complementary and alternative medical practices in the context of
rigorous science, train CAM researchers, and disseminate authoritative
information to the public and professionals. For additional information, call
NCCAM's Clearinghouse toll free at 1-888-644-6226, or visit
<http://nccam.nih.gov
The National Institutes of Health (NIH) -- The Nation's Medical Research Agency
-- includes 27 Institutes and Centers and is a component of the U. S. Department
of Health and Human Services. It is the primary federal agency for conducting
and supporting basic, clinical, and translational medical research, and it
investigates the causes, treatments, and cures for both common and rare
diseases. For more information about NIH and its programs, visit
<http://www.nih.gov
This NIH News Release is available online at:
<http://www.nih.gov/news/pr/may2007/od-03.htm

Hepatitis C Growth In Liver Cells Slowed By Protein
Main Category: Liver Disease / Hepatitis News
Article Date: 03 May 2007 - 2:00 PDT
Biomedical researchers have identified a cellular protein that interferes with
hepatitis C virus replication, a finding that ultimately may help scientists
develop new drugs to fight the virus.
The anti-hepatitis C activity of the protein, called "p21-activated kinase 1"
(PAK1), was discovered by scientists at the University of Texas Medical Branch
at Galveston (UTMB), who describe their findings in an article in the current
issue of the Journal of Biological Chemistry. In addition to presenting the
researchers' discovery that PAK1 controls the rate at which hepatitis C virus
replicates, the paper describes the biochemical pathways that lead to PAK1
activation and the specific mechanisms by which PAK1 interferes with the ability
of hepatitis C to hijack liver cells and make more copies of itself.
"Our findings reveal a novel cellular control pathway that regulates the growth
of hepatitis C virus within the cell," said Dr. Stanley M. Lemon, director of
the National Institutes of Health-funded Hepatitis C Research Center at UTMB and
of the academic medical center's Institute for Human Infections and Immunity.
Lemon, senior author of the Journal of Biological Chemistry paper, added,
"Understanding this better is likely to suggest new approaches to therapy for
this difficult to treat disease."
Hepatitis C chronically infects approximately 170 million people worldwide. The
most effective treatment for the virus, interferon-based therapy, eradicates the
virus less than 50 percent of the time and causes debilitating side effects.
Those for whom that treatment fails are at high risk for fatal cirrhosis or
liver cancer. In the United States, about half of all liver cancer cases occur
in people infected by hepatitis C virus.
The UTMB scientists reported their findings in the April 20 issue of the Journal
of Biological Chemistry. Their article is entitled "P21-activated Kinase 1 Is
Activated through the Mammalian Target of Rapamycin/p70 56 Kinase Pathway and
Regulates the Replication of Hepatitis C Virus in Human Hepatoma Cells."
###
In addition to Lemon, the other authors, all at UTMB, are postdoctoral fellow
Hisashi Ishida, Assistant Professor Kui Li and Associate Professor MinKyung Yi.
Funding for this research was provided by the National Institutes of Health.
The University of Texas Medical Branch at Galveston
Public Affairs Office
http://www.utmb.edu/
For more information or to schedule an interview or request a digital photo,
please call the media hotline.
Contact: Jim Kelly
University of Texas Medical Branch at Galveston
http://www.medicalnewstoday.com/medicalnews.php?newsid=69261&nfid=rssfeeds

New Test Helps Identify Hepatitis C Patients At High Risk Of Developing
Cirrhosis
Main Category: Liver Disease / Hepatitis News
Article Date: 02 May 2007 - 19:00 PDT
A researcher at the Stanford University School of Medicine has helped confirm
the reliability of a new test for liver disease that is ushering in the
long-promised era of personalized medicine based on each individual's genetic
makeup.
The Stanford group was one of the five sites that helped determine that the
genetic test can identify patients who are at high risk of developing cirrhosis
from chronic hepatitis C infection. That means high-risk patients could be
directed toward a long course of expensive, debilitating drug therapy, while
low-risk patients might be better off delaying treatment.
"Management of cirrhosis patients is challenging," said Ramsey Cheung, MD,
associate professor of medicine at the school and chief of hepatology at the
Palo Alto Veterans Affairs Health Care System, who led the Stanford arm of the
study. "This test is the first of its kind to use the genetic makeup of each
patient to determine who is likely to develop cirrhosis. High-risk patients
should be targeted for early treatment."
The test looks at variations of seven genes, and was developed by Celera,
headquartered in Rockville, Md.
Cheung is the senior author of the study, which will be published in the advance
online issue of the journal Hepatology. Cheung is a paid consultant for Celera,
which also funded the study.
"Current therapy for hepatitis C unfortunately is very expensive, has multiple
side effects and a suboptimal response rate for most patients," said Cheung.
Treatment includes weekly injections of alpha interferon along with the drug
ribavirin, which can cost more than $30,000 per year and can cause flu-like
symptoms, nausea, depression and other side effects. And only half of patients
undergoing this therapy will be cured of the infection.
Nearly 4 million Americans are infected with the hepatitis C virus, of which
nearly 80 percent have a chronic infection, according to the American Liver
Foundation. Chronic infection can lead to the severe scarring known as
cirrhosis, which in turn may result in liver cancer or liver failure. Hepatitis
C infection is the most common reason people need a liver transplant in the
United States and is responsible for between 8,000 and 10,000 U.S. deaths
annually.
But in the majority of people chronically infected with hepatitis C, the virus
causes either no symptoms or vague, nonspecific ones. In around one-third of
people chronically infected with the virus, the disease progression is slow and
they may never develop cirrhosis, even after decades of infection.
The dilemma physicians face, explained Cheung, is deciding who to treat and who
can wait for better therapies to come along. The key is being able to determine
which patients are likely to see the infection progress to cirrhosis. Doctors
consider such factors as age, gender and alcohol consumption to predict such
risk, but because of individual variability, these factors don't yield a very
accurate prediction. A liver biopsy can indicate the amount of damage to the
liver up until the time of the biopsy, but can't reveal how much future damage
will occur.
The new test assessed by Cheung and his colleagues is a way to hedge the bets.
The lead author of the paper is Hongjin Huang, PhD, associate director of liver
diseases at Celera in Alameda, Calif. Huang and her Celera colleagues developed
the test by initially scanning the DNA of more than 1,000 people who had
hepatitis C. Out of 25,000 genetic variations tested, the researchers discovered
seven that could be used together as a "signature" for predicting progression to
cirrhosis in Caucasians.
The resulting gene signature - the Cirrhosis Risk Score - was then independently
validated on 154 hepatitis C patients at Stanford, the University of
Illinois-Chicago and California Pacific Medical Center. Among patients with
early-stage liver disease, the researchers were able to divide them into a
high-risk category based on their gene pattern, compared with those who had
low-risk gene patterns. "The Cirrhosis Risk Score was superior to the known
clinical factors, such as alcohol consumption, in predicting the risk of
developing cirrhosis," said Cheung.
"This test allows both physicians and patients to make an intelligent decision
about the urgency of beginning antiviral therapy," he said. "If a patient turns
out to be low-risk, we might advise the patient to consider deferring treatment,
avoiding unnecessary side effects and expense of current therapy."
Last June, Celera licensed Specialty Laboratories of Valencia, Calif., to
perform the genetic test. The test currently costs about $500.
###
In addition to Cheung and Huang, the other 12 authors of the study are from
Celera, Virginia Commonwealth University, Mount Sinai School of Medicine,
California Pacific Medical Center, the University of Illinois-Chicago and the
University of California-San Francisco.
Stanford University Medical Center integrates research, medical education and
patient care at its three institutions - Stanford University School of Medicine,
Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford.
For more information, please visit the Web site of the medical center's Office
of Communication & Public Affairs at http://mednews.stanford.edu/.
Contact: Mitzi Baker
Stanford University Medical Center
http://www.medicalnewstoday.com/medicalnews.php?newsid=69228&nfid=rssfeeds

Preventing Hepatocellular Carcinoma in Patients with Chronic Hepatitis B
11th Online Posting Now Available
Hepatocellular carcinoma (HCC) is a highly lethal complication of cirrhosis and
chronic viral hepatitis. Patients with hepatitis B virus (HBV) infection are 100
times more likely to develop HCC than uninfected persons. Given that chronic
viral hepatitis is such an important cause of HCC, and that this cancer has such
a poor prognosis, it is critical to consider whether viral hepatitis-related HCC
can be prevented.
In Preventing Hepatocellular Carcinoma in Patients with Chronic Hepatitis B,
Adrian M. Di Bisceglie, MD, FACP, examines recent evidence suggesting that
antiviral therapy may play a significant role in preventing both primary
development of HCC as well as its recurrence in patients with chronic HBV
infection.
Read the 11th online posting now at www.projectsinknowledge.com/HBVpostings/.

Sexual Transmission of HCV Is Uncommon Among Heterosexual Injection Drug Users
By Liz Highleyman
Traditionally, it has been assumed that hepatitis C virus (HCV) was rarely
transmitted through sexual activity, largely basis on the low rates (0%-5%)
observed in epidemiological studies of monogamous heterosexual couples.
In recent years, however, this assumption has been called into question due to
outbreaks of apparent sexually transmitted HCV infection among gay men in the
U.K. and Europe. Most such cases have been seen in HIV positive men who have sex
with men (MSM), but a few have been reported in HIV negative MSM and HIV
positive women.
In the U.S., HCV is most commonly transmitted through shared use of drug
injection equipment. However, the contribution of sexual transmission among
injection drug users (IDUs) is unclear, and prior studies have produced
conflicting data.
As reported in the June 1, 2007 Journal of Infectious Diseases, researchers
assessed multiple risk factors for HCV infection using a novel multilevel
modeling technique designed to overcome the limitations of previous research.
The analysis included data on 265 drug-using couples in East Harlem in New York
City.
Results
. In a multivariate analysis, significant individual risk factors for HCV
included a history of injection drug use, tattooing, and older age.
. At the couple level, HCV infection tended to cluster within couples, and was
accounted for by drug-injection behavior.
. Individual-level and couple-level sexual behavior was not associated with
HCV infection in this model.
Conclusion
In conclusion the authors wrote, "Our results are consistent with prior research
indicating that sexual contact plays little role in HCV transmission. Rather,
couples' injection behavior appears to account for the clustering of HCV within
heterosexual dyads."
The greater apparent risk of sexual transmission of HCV among gay men may be due
to specific practices such as anal sex, fisting, group sex, and use of intrnasal
recreational drugs, that are more common in the MSM population.
05/04/07
References
JM McMahon, ER Pouget, S Tortu. Individual and Couple-Level Risk Factors for
Hepatitis C Infection among Heterosexual Drug Users. Journal of Infectious
Diseases 195(11): 1572-1581. June 1, 2007.
JA Hahn. Sex, Drugs, and Hepatitis C Virus. Journal of Infectious Diseases
195(11): 1556-1559. June 1, 2007.
http://www.hivandhepatitis.com/hep_c/news/2007/050407_a.html

Albumin Interferon May Be as Effective as Pegylated Interferon with Less
Frequent Dosing
By Liz Highleyman
Standard therapy for chronic hepatitis C using pegylated interferon plus
ribavirin is often limited by drug-related toxicities such as flu-like symptoms
and depression.
Both available forms of pegylated interferon alfa (Pegasys and PegIntron) are
injected once weekly -- which is a considerable improvement over conventional
interferon, which was administered 3 times per week. For some patients, less
frequent injection is associated with fewer side effects and improved quality of
life.
Human Genome Sciences and Novartis are collaborating on the development of an
even longer-acting form of interferon alfa -- albumin interferon (Albuferon) --
which can be injected once every 2 weeks. Data from studies of albumin
interferon were presented at the 42nd Annual Meeting of the European Association
for the Study of the Liver last month in Barcelona, Spain.
Genotype 1 Patients
In a late-breaker session, Stefan Zeuzem, MD, presented data from an ongoing
Phase IIb study evaluating the safety and efficacy of albumin interferon in
treatment-naive genotype 1 chronic hepatitis C patients. A total of 458 subjects
in 8 countries were randomly assigned to receive 1 of 3 doses of subcutaneous
albumin interferon -- 900 or 1200 mcg once every 2 weeks (Q2W) or 1200 mcg once
every 4 weeks (Q4W) - or else 180 mcg once-weekly Pegasys for 48 weeks; all
patients also received ribavirin.
Interferon efficacy is usually assessed based on sustained virological response
(SVR), or undetectable HCV RNA 24 weeks after the completion of therapy. Here,
the researchers reported interim "SVR12" results 12 weeks after the end of
therapy; follow-up is continuing.
Results
By intention-to-treat analysis, SVR12 rates in the various arms were as
follows:
o Albumin interferon Q2W 900 mcg: 59.3%;
o Albumin interferon Q2W 1200 mcg: 55.5%;
o Albumin interferon Q4W 1200 mcg: 52.6%;
o Pegylated interferon: 54.4%.
Among subjects who achieved at least 80% adherence to prescribe interferon and
ribavirin doses, SVR12 rates were higher across all arms, but the improvement
was most pronounced in the Q2W albumin interferon arms:
o Albumin interferon Q2W 900 mcg: 73.8%;
o Albumin interferon Q2W 1200 mcg: 72.0%;
o Albumin interferon Q4W 1200 mcg: 67.5%;
o Pegylated interferon: 63.0%.
Among heavier patients (75 kg or more, a group that responds more poorly to
therapy) with optimal adherence, SVR12 rates were maintained in the albumin
interferon arms, but lower in the pegylated interferon arm:
o Albumin interferon Q2W 900 mcg: 80.6%;
o Albumin interferon Q2W 1200 mcg: 70.4%;
o Albumin interferon Q4W 1200 mcg: 66.7%;
o Pegylated interferon: 56.7%.
Among adherent patients, relapse rates were reduced in all albumin interferon
arms, especially Q2W 900 mcg (13.0%), compared with pegylated interferon
(29.7%).
Rates of premature discontinuation due to adverse events in the 4 arms were as
follows:
o Albumin interferon Q2W 900 mcg: 9.3%;
o Albumin interferon Q2W 1200 mcg: 19.1%;
o Albumin interferon Q4W 1200 mcg: 12.1%;
o Pegylated interferon: 6.1%.
Quality of life as measured by the SF-36 scale was most favorable in the
albumin interferon Q2W 900 mcg arm.
Conclusion
The researchers concluded that, "These data suggest that the Q2W albumin
interferon regimens may offer at least comparable or increased efficacy, with an
improved dosing schedule and the potential for less impairment in quality of
life compared with Q1W pegylated interferon. The Q4W 1200 results warrant
further investigation of Q4W dosing in clinical trials."
J.W. Goethe-University Hospital, Germany; Hopital Pitie-Salpetriere, France;
University of Alberta, Canada; Hadassah University, Israel; Monash University,
Australia; Medical University of Bialystok, Poland; Spitalul Clinic de Adulti
Cluj-Napoca, Romania; Nuselská poliklinika - Remedis, Czech Republic; University
of British Columbia, Canada; University Of Manitoba, Canada; Duke Clinical
Research Institute, Durham, NC; Human Genome Sciences, Rockville, MD.
Genotype 2 or 3 Patient
In a second study, V.G. Bain and colleagues assessed albumin interferon in
treatment-naive patients with genotype 2 or 3 HCV. In this multicenter,
open-label Phase II trial, 43 subjects were randomly assigned to receive
subcutaneous albumin interferon at a dose of 1500 mcg either Q2W or Q4W plus 800
mg/day ribavirin. Patients were treated for 24 weeks, the standard duration of
pegylated interferon therapy for these genotypes.
Rapid virological response rates at week 4 were 76% in the Q2W arm and 68% in
the Q4W arm; after 24 weeks, however, the end-of-treatment response rates were
71% and 82%, respectively. Albumin interferon was well tolerated overall, with
similar safety profiles in the 2 dose groups. There were no dose reductions in
the Q4W arm compared with 10% in the Q2W. SVR data from this study are pending.
University of Alberta, Edmonton, Canada; University of Western Ontario, London,
ON, Canada; University of Manitoba, Winnipeg, MB, Canada; University of British
Columbia, Vancouver, BC, Canada; University of Calgary, Calgary, AB, Canada; Bar
Ilan University, Ramat-Gan, Israel; Duke Clinical Research Institute, Durham,
NC; Human Genome Sciences, Inc., Rockville, MD.
05/04/07
References
S Zeuzem, Y Benhamou, VG Bain, and others. Antiviral response at week 12
following competion of treatment with albinterferon alfa-2b plus ribavirin in
genotype 1, IFN-naive, chronic hepatitis C patients. 42nd Annual Meeting of the
European Association for the Study of the Liver (42nd EASL). Barcelona, Spain.
April 11-15, 2007.
VG Bain, P Marotta, K Kaita. Comparable antiviral response rates with albumin
interferon alfa-2b dosed at Q2W or Q4W intervals in naive subjects with genotype
2 or 3 chronic hepatitis C. 42nd EASL.
http://www.hivandhepatitis.com/2007icr/easl/docs/050407_a.html

Health Department encourages testing for hepatitis C
Published: Thursday, May 3, 2007
The Vermont Department of Health is working to raise awareness about hepatitis
C, a potentially fatal liver disease that has affected as many as 12,000
Vermonters, according to national statistics.
"Most people living with hepatitis C are not aware that they have the disease,"
said acting Health Commissioner Sharon Moffatt. "A simple blood test can detect
the virus, and people who are most at high risk for exposure to the virus are
encouraged to get tested."
May is National Viral Hepatitis Awareness Month. In March, the Health Department
started a new program that offers free and anonymous hepatitis C testing at the
three syringe-exchange programs in Burlington, St. Johnsbury and White River
Junction.
Because injection drug users are at highest risk for exposure, low-cost sterile
syringes also are available without a prescription at some pharmacies in
Vermont.
For more information about hepatitis C, visit the Health Department Web site at
www.HealthVermont.gov
http://www.burlingtonfreepress.com/apps/pbcs.dll/article?AID=/20070503/NEWS/7050\
3014

Some 35,000 people in Ontario have hepatitis C and don't know it: Gov't ads
Published: Tuesday, May 1, 2007 | 1:01 PM ET
Canadian Press
TORONTO (CP) - Ontario health officials say some 35,000 people across the
province are infected with hepatitis C and don't know it.
That statistic is part of an advertising campaign launched today to raise
awareness in Ontario. The campaign will include TV commercials in eight
different languages, ads in almost 300 newspapers, and an online campaign.
The ads will point people to a new website, which includes an anonymous quiz to
determine whether you're at risk for contracting the disease.
Hepatitis C, commonly spread through intravenous drug use, can cause cirrhosis
and liver cancer.
Overall, officials say about 110,000 Ontarians have the viral infection.
http://www.cbc.ca/cp/health/070501/x05019A.html

Liver stiffness indicates severe portal hypertension in patients with
hepatitis C-related cirrhosis
Medical Studies/Trials
Published: Wednesday, 2-May-2007
Measuring liver stiffness using transient elastography can predict severe
portal hypertension in patients with hepatitis C-related cirrhosis, according to
a new study in the May issue of Hepatology, the official journal of the American
Association for the Study of Liver Diseases (AASLD).
As liver disease progresses, fibrosis leads to portal hypertension which
causes potentially lethal complications such as variceal hemorrhage, ascites and
portosystemic encephalopathy. Measuring the hepatic venous pressure gradient
(HVPG) is the standard method used to assess portal pressure and predict its
complications; however, the procedure is invasive, expensive, and requires
technical expertise.
In search of another way to assess liver fibrosis and portal hypertension,
researchers, led by Massimo Pinzani, MD, PhD, of the University of Florence,
sought to evaluate transient elastography, a rapid, non-invasive technique to
measure liver stiffness. They compared its accuracy in detecting portal
hypertension and its complications with that of HVPG measurement.
Between March 1, 2005 and July 1, 2006, the researchers studied 61
consecutive patients with diagnosed or suspected cirrhosis from chronic HCV
infection. Each patient underwent transient elastography to measure liver
stiffness. Immediately afterward, they underwent HVPG measurement and liver
biopsy. The researchers then analyzed the data and compared the diagnostic
tools.
"Considering the whole patient population, a statistically significant,
positive correlation between HVPG and liver stiffness measurement was found,"
they report. The correlation was excellent for HVPG values less than 10 or 12
mmHg, but not as good for greater HVPG values. They also noted a correlation
between liver stiffness measurement and the presence of esophageal varices,
however, the negative and positive predictive values for the detection of
varices were unsatisfactory, at 66 percent and 77 percent respectively.
"We suggest that measurement of liver stiffness by transient elastography
may represent a reliable non-invasive methodology for the prediction of
clinically significant and severe portal hypertension, although not good enough
to replace endoscopy for the detection of varices," the authors conclude.
An accompanying editorial by Joseph Lim of Yale University School of
Medicine and Roberto Groszmann of VA Connecticut Healthcare System and Yale
University applauds the study as the first to evaluate the correlation between
liver stiffness measurement and clinically significant portal hypertension as
reflected by both direct HVPG measurement and the identification of esophageal
varices on upper GI endoscopy.
"Additional validation studies evaluating its diagnostic accuracy in a
representative American population are needed prior to regulatory approval and
wide application to clinical practice," the editorial authors note, particularly
because the average BMI of the study population was 23, which contrasts to
higher mean BMIs in the U.S. population. To date HVPG still is the gold
standard.. for predicting clinical decompensation and the response of portal
pressure to pharmacological therapy.
http://www.interscience.wiley.com/journal/hepatology
http://www.news-medical.net/?id=24589

Millions Of Chickens Fed Tainted Pet Food
Risk to Consumers Minimal, FDA Says
By Rick Weiss
Washington Post Staff Writer
Wednesday, May 2, 2007; Page A01
At least 2.5 million broiler chickens from an Indiana producer were fed pet food
scraps contaminated with the chemical melamine and subsequently sold for human
consumption, federal health officials reported yesterday.
Hundreds of other producers may have similarly sold an unknown amount of
contaminated poultry in recent months, they added, painting a picture of much
broader consumption of contaminated feed and food than had previously been
acknowledged in the widening pet food scandal.
Officials emphasized that they do not believe the tainted chickens -- or the
smaller number of contaminated pigs that were reported to have entered the human
food supply -- pose risks to people who ate them.
"We do not believe there is any significant threat of human illness from this,"
said David Acheson, the Food and Drug Administration's chief medical officer.
FDA Commissioner Andrew von Eschenbach named Acheson yesterday the agency's new
"food czar" -- officially, assistant commissioner for food protection.
None of the farm animals is known to have become sick from the food, and very
little of the contaminant is suspected of having accumulated in their tissue.
Thus, no recall of any products that may still be on store shelves or in
people's freezers is planned, officials said.
Nonetheless, 100,000 Indiana chickens that ate the melamine-laced food and are
still alive have been quarantined and will be destroyed as a precautionary
measure -- as will any other animals that turn up as the investigation continues
to expand.
The revelations are the latest in a rapidly widening scandal that started out
with reports of a few deaths of pets. It has mushroomed into a major debacle
that, even if no human injuries emerge, has exposed significant gaps in the
nation's food-safety system.
In the first volley of what Hill watchers expect to be a series of proposed
fixes, Sen. Richard J. Durbin (D-Ill.) and Rep. Rosa DeLauro (D-Conn.) yesterday
introduced legislation that would give the FDA the power to order mandatory
recalls of adulterated foods, establish an early warning and notification system
for tainted human or pet food, and allow fines for companies that do not
promptly report contaminated products.
Meanwhile, the FDA expanded the number of plant-based protein products from
China on its "do not import" list, pending the completion of further tests on
various kinds of glutens, protein concentrates and other products.
At the center of the problem are pet foods spiked with melamine, a mildly toxic
chemical that can make food appear to have more protein than it does. Most of
the food went to pets, but scraps were sold in February to the Indiana poultry
producer, officials said. The contaminated material may have made up about 5
percent of the chickens' total food supply.
That small fraction, and the fact that people, unlike pets, do not eat the same
thing day after day, suggests that consumers who ate contaminated pork or
chicken would probably have ingested extremely small doses of melamine, well
below the threshold for causing health effects, officials said. Experts
conceded, however, that they know little about how the toxin interacts with
other compounds in food.
Investigators are tracking streams of the contaminated food through several
states.
"Our sense is that the investigation will lead to additional farms where
contaminated feed may have been fed to either animals or poultry," said Kenneth
Petersen of the Agriculture Department Food Safety and Inspection Service.
Officials said the FDA has received 17,000 reports of pets that owners believe
were sickened or killed by contaminated food. About 8,000 reports, roughly half
of them involving animals that died, have been formally entered into the FDA's
tracking system for further analysis.
U.S. investigators have arrived in China, officials said, but inspections of
production facilities there have been hampered by the start yesterday of a
week-long national vacation.
"Essentially, all the officials are on holiday," said Walter Batts, part of the
FDA's China team, adding that one Chinese official had stayed behind to help.
http://www.washingtonpost.com/wp-dyn/content/article/2007/05/01/AR2007050102071.\
html?referrer=emailarticle

Hello all. If you are interested in the link to the online pictures of
Florida's Hepatitis Awareness Day it is:
http://www.kodakgallery.com/I.jsp?c=k8kfcz3.ckrkfi83&x=1&y=fo7n5q Just a
reminder that Kodak is FREE to join and look at them. Again, I apologize for
my camera date being off by a day. I am resetting it NOW since this has
happened to me twice this year :-( Sorry! Both Georgia's and Florida's Hep
Day were a day later than the pictures reflected.
If you missed the Georgia Hep Day link it is:
http://www.kodakgallery.com/I.jsp?c=k8kfcz3.52kpey2b&x=1&y=etcyc4
Also if you have a Hepatitis Awareness Day in your State please try to attend
and *Make A Difference*! If you don't have a Hep Day yet I hope that you can
help put one together. We need to continue to spread the word about Hepatitis
- especially Hepatitis C! Send me a link to your State's pictures and I will
be sure to spread the word on the internet!
Peace
Pam Langford
President
H.E.A.L.S of the South
http://www.HEALSoftheSouth.org
http://www.HEALSoftheSouth.com
http://www.HEALSofNGA.org (formerly)
850-443-8029 Cell
North Florida Chapter
http://www.HEALSofNFL.bravehost.com
Florida Online Support Group

Governors Kulongoski and Gregoire Proclaim May 2007 Hepatitis Awareness Month
"The Silent Epidemic" Gains Voices
OREGON CITY, OR -- (MARKET WIRE) -- April 30, 2007 -- The Hepatitis C Caring
Ambassadors Program (HCCAP) applauds Governors Kulongoski and Gregoire for
recognizing viral hepatitis as a serious threat to public health by issuing
proclamations recognizing Hepatitis Awareness month in their respective states.
Hepatitis C is the most common chronic, blood-borne viral infection in the
United States, and is the leading cause of chronic liver disease. An estimated 5
million Americans have been infected with the hepatitis C virus (HCV) including
at least 171,000 citizens in Oregon and Washington.
HCCAP Program Director, Lorren Sandt, said of the proclamations, "Raising
awareness among the general public about hepatitis C is especially important
since the majority of people living with hepatitis C remain undiagnosed. People
cannot change the course of their disease or protect their loved ones if they
are unaware of their own health status."
HCCAP's efforts during Hepatitis Awareness Month are focused on educating the
general public and policy-makers about both the health threat posed by hepatitis
C and the opportunity to turn the tide on this public health crisis. The death
rate from hepatitis C is expected to triple from 2010 to 2019. Increased testing
and treatment can help curb this dire prediction. "Hepatitis C is a rarity among
viral illnesses in that we have medications that cure the disease in
approximately half of those who undergo treatment," said Dr. Tina St. John,
Medical Director of HCCAP. She added, "In the near future, we hope to improve
therapies so that cure is possible in nearly all people treated. There are
several products currently in clinical trials showing very promising preliminary
results."
Lorren Sandt noted, "The number of people in Oregon and Washington living with
hepatitis C would fill the Rose Garden more than 8 times. We have an opportunity
to help every one of those individuals, but we must act now. Thank you,
Governors Kulongoski and Gregoire, for taking action!"
About Hepatitis C Caring Ambassadors Program
The Hepatitis C Caring Ambassadors Program (HCCAP) is a division of the national
nonprofit public charity, the Caring Ambassadors Program, Inc. Headquartered in
Oregon City, Oregon, HCCAP is committed to improving the health and longevity of
those living with chronic hepatitis C through information, awareness, and public
advocacy.
Contact:
Lorren Sandt
503-632-9032
Email Contact
SOURCE: Hepatitis C Caring Ambassadors Program
http://www.marketwire.com/mw/release_html_b1?release_id=244672

Hepatitis awareness gets push from local lawmakers
Harrisburg - A House resolution designating May as Hepatitis Awareness
Month has passed the House unanimously, according to prime sponsor Rep. Mario
Scavello (R-Monroe) and supporter Mike Peifer (R-Monroe/Pike/Wayne).
"I have been working with local organizations to promote hepatitis
awareness for the last several years to call attention to a devastating health
problem and communicable disease," said Scavello. "I'd like to recognize Howard
Kindred, CEO and founder of the Northeastern Pennsylvania Transplant Support
Group for all of his efforts to promote hepatitis awareness."
Hepatitis comes in five forms, A, B, C, D and E and is often asymptomatic,
appearing first as an inflammation of the liver. It is contracted from
contaminated food and water. Hepatitis C is the leading cause of liver
transplantation, and affects 280,000 Pennsylvanians. A vaccine is readily
available for hepatitis A and B. Hepatitis B and C are considered by the World
Health Organization as a disease of primary concern for humanity.
"Hepatitis A and B can be prevented by public education, vaccines and
avoiding certain behavioral risk factors," said Peifer. "The more we get the
word out to health care workers, emergency services workers, veterans and the
general public, the better chance we have of controlling the spread of this
devastating illness.
The resolution calls on state agencies, health care providers and
Pennsylvania residents to learn and educate others about the disease so that the
causes, symptoms, diagnosis and treatment of hepatitis can occur in a timely
fashion.
Two people are diagnosed with hepatitis-related liver disease and two
people die from liver cancer each day in the United States.
People at risk of contracting hepatitis include:
a.. People who had blood transfusions before 1992.
b.. People who have frequent exposure to blood products, including
patients with hemophilia, solid organ transplants, chronic renal failure or
cancer requiring chemotherapy.
c.. Health care workers who suffer needle sticks.
d.. People who engage in high-risk sexual behavior, have multiple sex
partners or sexually transmitted diseases.
e.. People who are or have been on hemodialysis.
f.. People who have their body pierced or have tattoos.
g.. People who have injected drugs, even once.
h.. People who use cocaine, particularly with intranasal administration,
using shared equipment.
House Resolution 254 passed 192-0 on April 25. For more information on
hepatitis, visit the Northeastern Pennsylvania Transplant Support Group Web site
at www.nepatsg.org.
http://www.pocononews.net/news/May07/01/01May07-2.html

Just a reminder that the first Hepatitis C Awareness Day will be held in
Jefferson City on May 10, 2007 from 8:00 am till 1:00 pm.
This day is for all who care about this disease and the time to let your
legislators know that it needs to be addressed and not on the back burner.
Legislators will pass by us as we will be located in the Rotunda next to their
chambers. Your Representative and Senator will pass by, you need to be there. We
will have a directory of all the legislators so you may find yours.
"Pictures say a thousand words" we will have the Honor/Memory board with
pictures of those we love on it. Bring yours.
Legislators will nod at a small group, they may pause at a larger group, they
will be compelled to stop at a very large group.
Don't think that you not being there won't make a difference. Every person there
makes a difference.
Hope to see you there. Pass the word. Thanks.
Kathie Bryson
" How wonderful is it that nobody need wait a single
moment before starting to improve the world." (Anne Frank)

FOR IMMEDIATE RELEASE Contact: Wendy Riemann
May 1, 2007 (850)
245-4111
FLORIDA DEPARTMENT OF HEALTH (DOH) KICKS OFF HEPATITIS AWARENESS MONTH WITH
HEPATITIS DAY AT THE CAPITOL
-Focus on Immunization Strategy to Eliminate Hepatitis B-
TALLAHASSEE- The Florida Department of Health (DOH) celebrates the first day of
National Hepatitis Awareness Month with Hepatitis Day at the Capitol. The
purpose of the event is to promote hepatitis awareness and education, as well as
encourage hepatitis testing, vaccination and prevention methods.
Hepatitis is characterized by inflammation of the liver. Hepatitis A, B and C
are the most common types of viral hepatitis in the United States. Symptoms of
hepatitis, if they are present, include nausea, fever, weakness, loss of
appetite and jaundice. The Centers for Disease Control and Prevention (CDC) has
issued guidance on an initiative to eliminate hepatitis B in the United States.
"The Bureau of Immunization and the Bureau of HIV/AIDS Hepatitis Prevention
Program are working together to provide over 17,000 additional doses of
hepatitis B (HBV) vaccine to at-risk adults," DOH Deputy State Health Officer
Bonita Sorensen M.D., M.B.A. said. "Public health in Florida has already done a
commendable job of significantly reducing hepatitis B in infants, children and
adolescents. Here is our opportunity to do the same for adults who are at
risk."
Most county health departments throughout Florida offer free hepatitis vaccine
and testing to adults at risk. During Hepatitis Awareness Day at the Capitol,
the Leon County Health Department provided free hepatitis B and free hepatitis A
(HAV) vaccines to adults. There is no vaccine for hepatitis C (HCV).
Almost four million Americans and more than 300,000 Floridians are infected with
the hepatitis C virus. Hepatitis C is referred to as the 'silent epidemic'
because most people are unaware they are infected due to a lack of symptoms. The
disease often lies undetected for 20-30 years and is a leading cause of liver
cirrhosis and liver failure.
Hepatitis C is usually spread through contact with blood containing the virus.
All individuals infected with HCV should be vaccinated for HAV and HBV, as both
viruses can cause further liver damage. Hepatitis A is transmitted by eating
food or drinking water that has been contaminated with human waste (feces).
Hepatitis B is spread through contact with the blood or body fluids of an
infected person.
For more information, please visit
http://www.doh.state.fl.us/disease_ctrl/aids/hep/index.html.

Student power at its best
Bindu Shajan Perappadan
Youth for Equality to raise 12 lakh for kid's liver transplant
NEW DELHI: It's student power at its best. Students from the All-India Institute
of Medical Sciences, Jawaharlal Nehru University, Delhi University and others
from across the country have got together under the Youth for Equality banner to
raise Rs. 12 lakh needed for an 11-year-old boy from Assam, Ankit Singh, who is
to undergo liver transplant surgery at Sir Ganga Ram Hospital here.
Geared up for some "constructive" action and all set to draw public attention,
the students are determined to give Ankit a fighting chance at survival.
Ankit, who according to doctors is ailing from end-stage liver disease, needs a
transplant to survive. The cost of the surgery, however, is unaffordable for his
parents who have travelled from Assam early this month to get the child admitted
to Sir Ganga Ram Hospital after his condition suddenly deteriorated.
"Ankit's liver was damaged since his childhood and he has been undergoing
treatment for it. Earlier the doctors were not able to pinpoint the cause of his
condition and were prescribing symptomatic treatment. Later we were told that
there was extensive liver damage and that he will not be able to survive without
an immediate transplant," said Ankit's father Amarjeet Singh.
Appeal to President
"We have written to the President and the Prime Minister asking for help after
we exhausted our resources. However, we have not got any response. This appeal
is our last and only hope. This is Ankit's last chance," added a tearful Mr.
Singh.
The students at AIIMS have already put up posters asking the public to donate
generously to help the boy. They will also hold a health camp at the JNU campus
where a donation box will be kept for little Ankit.
"Together we are sure we can raise enough money to get the child operated upon.
The child is to be operated upon at Sir Ganga Ram Hospital. The father is sure
that he can take care of the medical expenses after the child is operated. We
are mobilising students across the country and we hope the public will stand by
us and not let the child die due to want of money to get medical treatment,"
said Dr. Kumar Harsh, president of the Resident Doctors' Association at AIIMS
and member of Youth for Equality.
Meanwhile, Ankit's doctors at Sir Ganga Ram Hospital, Dr. Neelam Mohan,
Consultant Paediatric (Gastro-enterologist and liver specialist), has already
managed to raise a lakh to help the boy and is keen that he be operated upon as
soon as possible.
"Ankit is critical and will not survive in case he is not operated upon soon. We
are with the youth who have taken it upon themselves to raise money for the
child," said Dr. Mohan.
http://www.hindu.com/2007/04/28/stories/2007042820360500.htm

God answers prayers specifically
I was driving home after work one night in my five-speed Toyota in 1989 after
the big Loma Prieta earthquake in San Francisco. Since the Bay Bridge was
damaged, traffic on the two bridges that span the East Bay from the Peninsula
were packed. I was sitting on the Dumbarton bridge kvetching to myself because I
had to keep shifting.
As I was sitting in traffic, I suddenly had what I thought was a bright idea. I
asked God to total my car so that I could get an automatic with the insurance
proceeds (this from a claims person!). "I don't want anybody to get hurt, Lord,"
I said, as usual placing conditions on things. "Just let someone hit it when
it's parked or something, okay?"
I went home and took a nap, then about 7:30 headed out for the Friday night NA
meeting at Laney College near my apartment in Oakland. After the meeting, as we
always did, a gang of us headed out to meet at Biff's, a downtown 24-hour coffee
shop, a fixture for those in recovery. I had actually worked there in my teens,
but that's a whole other story in itself.
As I was making a left turn to go onto Grand Avenue and into Biff's parking lot,
a drunk kid made a left and smacked my car. The total damage to my car was
$1,500, but it dislocated my shoulder and it never healed quite right. God had
answered my prayers, alright, but I think He sent a bigger message.
Another example of God's answers is when I received my liver. Before the
transplant center puts you on the transplant list, you have to interview with a
team, and I mean team, of psychiatrists. There were about six of them in the
room, all I really recall is a sea of white coats. They asked me how I felt
about having someone's else's organ in me.
Despite how sick I was, I hadn't totally lost my sense of humor, but I felt I'd
better let the wording of that question pass. I did say that I didn't have a
problem with it, but I had one request. I told them that I'd always been
slightly pissed off, I wasn't sure why. I said that I believed the liver
controlled emotions and that I hoped that I would get a happy liver.
They were trying not to laugh when they answered me, but I could tell they were
pretty amused and thinking "This one's a coo-coo bird." The head of the team
told me that they were going to get me a liver because I'd led a "phenomenal
life," but they couldn't guarantee that they could find me a happy liver.
"Well, I guess then any liver will do," I told them.
At a year post-transplant, I wrote a letter to the donor family. The letter they
sent back said they'd sent me a picture of their five-year old daughter who gave
me her liver so I could she that she "was such a happy child."
How's that for God's answer to my prayer?
Today when things get tough, I know that there is a light at the end of the
tunnel. That light is God's love guiding me toward Him. "It's better over here,"
I think He coaxes sometimes when I'm doubtful.
They say fear and faith cannot exist in the same space; that fear is lack of
faith. I know that I can be scared to death but still have faith in God. I know
that ultimately all will be well, but the steps I have to take in the meantime
sometimes frighten me.
After all these years clean, I can finally say my faith is strong. Until
tomorrow, I feel your love and thank you for your friendship.
Posted by twodogsblogging at Saturday, April 28, 2007
http://twodogsbarking.blogspot.com/2007/04/god-answers-prayers-specifically.html

Needle exchange program
Jennifer Kielman
Video Low
Video High
Some state lawmakers are trying to stop the spread of HIV and hepatitis C with a
controversial new program.
The Senate recently passed a bill designed to help drug users, and although it
hasn't hit the house floor just yet, it's causing quite a commotion for those
KETK 56 News spoke with.
"I know there are cities in Europe, like Amsterdam that have started out with
needle exchanges, and now it's the drug capitol of Europe."
A new bill just passed by the state Senate would allow local health departments
to start needle-exchange programs to help reduce the spread of disease by
intravenous drug use.
The idea is to allow drug users to take their dirty needles to their local
health department and switch them out for new ones.
The sponsor of the bill, state Senator Bob Deuell, says, "Needle-exchange
programs were once thought to be a radical idea. But research shows that as many
as 20 percent of addicts who participate in needle-sharing programs also seek
drug-treatment programs."
The executive director of Tyler AIDS services, Reed Hunsdorfer, agrees.
Hunsdorfer said, "I don't think there's gonna be any more drug use. I think
it'll be safer drug use, but people will find syringes and needles anywhere they
can."
On the other hand, those who oppose the bill say it'll promote drug use and
doesn't send a very good message to East Texans.
"Anytime it has to do with introvene of injection of drugs, I just don't like
it. I don't like the state getting into this business."
In fact, Berman says he'll veto it once it hits the House floor.
"I don't want to attract drug users to Texas. I understand it could possibly
save a life of some drug users and can get clean needles."
He says the money that would be spent on the needle-exchange bill would be
better spent on drug rehab programs.
To date Texas has more than 56,000 people living with the HIV virus. In Tyler
there are about 300 people living with it.
Story Created: Apr 27, 2007 at 10:13 PM CDT
http://www.ketknbc.com/news/local/7232486.html

Hepatitis C Patients Who Are At High Risk Of Developing Cirrhosis Can Now Be
Reliably Identified
Science Daily - A researcher at the Stanford University School of Medicine has
helped confirm the reliability of a new test for liver disease that is ushering
in the long-promised era of personalized medicine based on each individual's
genetic makeup.
The Stanford group was one of the five sites that helped determine that the
genetic test can identify patients who are at high risk of developing cirrhosis
from chronic hepatitis C infection. That means high-risk patients could be
directed toward a long course of expensive, debilitating drug therapy, while
low-risk patients might be better off delaying treatment.
"Management of cirrhosis patients is challenging," said Ramsey Cheung, MD,
associate professor of medicine at the school and chief of hepatology at the
Palo Alto Veterans Affairs Health Care System, who led the Stanford arm of the
study. "This test is the first of its kind to use the genetic makeup of each
patient to determine who is likely to develop cirrhosis. High-risk patients
should be targeted for early treatment."
The test looks at variations of seven genes, and was developed by Celera,
headquartered in Rockville, Md. Cheung is the senior author of the study, which
will be published in the journal Hepatology. Cheung is a paid consultant for
Celera, which also funded the study.
"Current therapy for hepatitis C unfortunately is very expensive, has multiple
side effects and a suboptimal response rate for most patients," said Cheung.
Treatment includes weekly injections of alpha interferon along with the drug
ribavirin, which can cost more than $30,000 per year and can cause flu-like
symptoms, nausea, depression and other side effects. And only half of patients
undergoing this therapy will be cured of the infection.
Nearly 4 million Americans are infected with the hepatitis C virus, of which
nearly 80 percent have a chronic infection, according to the American Liver
Foundation. Chronic infection can lead to the severe scarring known as
cirrhosis, which in turn may result in liver cancer or liver failure. Hepatitis
C infection is the most common reason people need a liver transplant in the
United States and is responsible for between 8,000 and 10,000 U.S. deaths
annually.
But in the majority of people chronically infected with hepatitis C, the virus
causes either no symptoms or vague, nonspecific ones. In around one-third of
people chronically infected with the virus, the disease progression is slow and
they may never develop cirrhosis, even after decades of infection.
The dilemma physicians face, explained Cheung, is deciding who to treat and who
can wait for better therapies to come along. The key is being able to determine
which patients are likely to see the infection progress to cirrhosis. Doctors
consider such factors as age, gender and alcohol consumption to predict such
risk, but because of individual variability, these factors don't yield a very
accurate prediction. A liver biopsy can indicate the amount of damage to the
liver up until the time of the biopsy, but can't reveal how much future damage
will occur. The new test assessed by Cheung and his colleagues is a way to hedge
the bets.
The lead author of the paper is Hongjin Huang, PhD, associate director of liver
diseases at Celera in Alameda, Calif. Huang and her Celera colleagues developed
the test by initially scanning the DNA of more than 1,000 people who had
hepatitis C. Out of 25,000 genetic variations tested, the researchers discovered
seven that could be used together as a "signature" for predicting progression to
cirrhosis in Caucasians.
The resulting gene signature - the Cirrhosis Risk Score - was then independently
validated on 154 hepatitis C patients at Stanford, the University of
Illinois-Chicago and California Pacific Medical Center. Among patients with
early-stage liver disease, the researchers were able to divide them into a
high-risk category based on their gene pattern, compared with those who had
low-risk gene patterns. "The Cirrhosis Risk Score was superior to the known
clinical factors, such as alcohol consumption, in predicting the risk of
developing cirrhosis," said Cheung.
"This test allows both physicians and patients to make an intelligent decision
about the urgency of beginning antiviral therapy," he said. "If a patient turns
out to be low-risk, we might advise the patient to consider deferring treatment,
avoiding unnecessary side effects and expense of current therapy."
Last June, Celera licensed Specialty Laboratories of Valencia, Calif., to
perform the genetic test. The test currently costs about $500.
In addition to Cheung and Huang, the other 12 authors of the study are from
Celera, Virginia Commonwealth University, Mount Sinai School of Medicine,
California Pacific Medical Center, the University of Illinois-Chicago and the
University of California-San Francisco.
Note: This story has been adapted from a news release issued by Stanford
University Medical Center.
http://www.sciencedaily.com/releases/2007/04/070427072159.htm

Toddler alive because of organ donation
Hundreds attend annual Organ Donor Awareness Walk in Sudbury
Laura Stradiotto
Local News - Saturday, April 28, 2007 Updated @ 5:29:14 PM
If it wasn't for some stranger who took the time to fill out an organ donor
card, Jack Lalonde may have not seen beyond the first seven months of his little
life.
The toddler suffered from biliary atresia, which destroyed the bile ducts inside
his liver at birth.
At six-months old, Jack was listed for a liver transplant. A month later he
received the transplant.
"He got a piece of an adult's liver and I'm sure some kids can wait a lot longer
than that" for a matched donor, said his mother Nicole.
"We were just lucky with his blood type and his size."
Now at two-and-a-half years old, Jack is relying on the organ of another donor.
"We just found out he is having problems with his bile ducts, and he will need
another transplant," said Nicole.
"He's not listed yet, but he will be in the future."
Jack and his parents, Nicole and Matt are from Woodstock, Ont. Matt, who is
originally from Sudbury, returned to his hometown this weekend for the Irish
Heritage Club of Sudbury's annual Organ Donor Awareness Walk.
Hundreds of people showed up at Bell Park on Saturday morning wearing green
raincoats. Their movement was orchestrated to form a living green ribbon - the
colour of the campaign. The living green ribbon represents the lives that can be
saved or enhanced through organ and tissue donation.
"He's doing really good now," Nicole said of her son. "He was doing well for 17
months and then he started to go jaundice again. Doctors started to think
something was wrong and he went through a bunch of tests."
Doctors located strictures on Jack's liver, which is a narrowing of the bile
ducts, his mother explained.
"They really don't know why, but it just happens sometimes," said Nicole.
http://www.thesudburystar.com/webapp/sitepages/content.asp?contentid=507015&catn\
ame=Local+News&classif=News+Live

Recognition of brain death will aid organ transplants
(Xinhua)
Updated: 2007-04-29 07:03
BEIJING -- The question of what constitutes death is at the center of a
medico-legal debate in China with important implications for organ transplants,
a senior health official said on Saturday.
In April, China issued its first regulation on human organ transplants, aimed at
banning organ trade in any form and regulating the country's huge organ
transplant market. It will go into effect on May 1.
The new organ transplant regulations are a milestone in China's health sector,
but the legal framework remains incomplete, vice minister of health Huang Jiefu
told a press briefing, pointing out that new legislation on "brain death" is
needed.
He said the development of human organ transplants requires a wider medical
definition of death besides the traditional notion of cessation of heartbeat.
"Fifteen minutes at most after the cessation of heartbeat and breathing, organs
are irreparably damaged and can no longer be harvested for transplants," said
Huang, a liver transplant specialist, who completed his postdoctoral research at
the University of Sydney, Australia.
Most western countries stopped using cessation of heartbeat as a sign of death
before organ removal in 1968. Instead they use the concept of "brain death", the
criteria for which include absence of brain-stem reflexes, no evidence of
breathing and total lack of consciousness.
Organs can be successfully harvested from a person who is brain dead but whose
heart and lungs are kept functioning by machines.
However, the traditional Chinese view that "life goes on until the last breath
and until the heart stops beating" has held back the introduction of legislation
on brain death even though academics have been urging the promulgation of such a
law since the 1980s.
Chinese medical experts say that if the law was amended to allow organs to be
removed from people declared "brain-dead", organ supply would increase
significantly.
China has been carrying out organ transplants for more than 20 years and is the
world's second largest performer of transplants after the United States. But
there is a terrible shortage of organs. Official statistics show that while 1.5
million patients need organ transplants each year, only 10,000 can find organs.
Most organs are donated by ordinary citizens at their death who have voluntarily
signed a donation agreement.
As China's human organ transplant regulations do not recognize brain death, it
is currently illegal to take organs from a brain-dead patient for transplant
purposes, Huang previously said.
Huang, who has long advocated the recognition of brain death, said an academic
seminar planned for the second half of the year will examine the concept of
brain death, which is widely misunderstood by ordinary Chinese.
"China will seek to change people's traditional views and -- in a context of
worldwide shortage of organs -- encourage a humanitarian spirit of helping each
other," Huang said in an earlier interview in March.
"The country will probably establish a range of death criteria covering brain
activity, breathing and cessation of heartbeat and allow people to choose the
criteria that seem most appropriate to them," he said.
Huang gave no more details of the legislation but stressed that the drafters
will ensure the doctors who pronounce "brain death" are not the ones responsible
for organ transplants.
Recognition of brain death is part of a package of criterion the ministry of
health is drawing up to implement the human organ transplant regulation, Huang
said.
Most of the criterion will be completed in three to five years, he said, adding
that a manual on liver transplant, the first of its kind, will be released in
this August, followed by the manual on kidney transplant.
On Saturday, the health ministry also announced that the first batch of more
than 160 medical institutes have been granted the licence to transplant human
organs.
About 600 hospitals and clinics have applied, the ministry said.
http://www.chinadaily.com.cn/china/2007-04/29/content_863233.htm

UMC losing transplant doctors
3 departures include abdominal, lung surgeons, kidney specialist
By Carla McClain
Arizona Daily Star
Tucson, Arizona | Published: 04.28.2007
In yet another round of high-profile physician exits from University Medical
Center, the hospital is losing two top organ-transplant surgeons and a
specialist who oversees kidney transplants.
Among those leaving is Dr. Ernesto Molmenti, who arrived at UMC only two years
ago to revive the defunct liver transplant program and strengthen the faltering
kidney and pancreas transplant programs.
These latest departures follow the resignations, confirmed earlier this week, of
UMC's chief trauma surgeon, Dr. John Porter, along with two other trauma
surgeons, all serving the city's lone trauma center.
Although hospital officials insist these losses are merely coincidental, and
part of the academic contract cycle at this time of year, rumors of internal
turmoil have been circulating within UMC in recent months.
"Physician turnover is obviously a way of life in academic health centers, so
that is something we just have to deal with," said Dr. Keith Joiner, dean of the
University of Arizona College of Medicine.
"What is happening is part of the larger national issue â the widening gap
between private-practice salaries and academic salaries. At a teaching hospital,
the teaching must be paid for, with funds that might go to salaries and
benefits. It's a fact of life.
"Dr. Molmenti's case is the best example. The package he's being offered is just
way out of our reach. In certain specialties â and transplant is one of them
â private practice is paying salaries two to three times what teaching
hospitals can pay."
Molmenti will join North Shore University Hospital on Long Island, N.Y., to open
a new kidney-transplant center there in June.
"Yes, we've seen some major losses," Joiner said.
"They are tough, but we're hardly going to give up. We're going to deal with
these pressures, though we know it's not going to get easier."
Along with Molmenti, UMC will lose lung-transplant surgeon Dr. Kimberly Gandy,
who also is a pediatric heart surgeon, and Dr. Sam James, a nephrologist who is
medical director of the kidney-transplant program.
Molmenti arrived at UMC with considerable fanfare in summer 2005, recruited from
Johns Hopkins University School of Medicine in Baltimore. Named chief of
abdominal transplantation, he restarted the liver-transplant program within
months, after its shutdown amid controversy four years earlier.
During his two years here, he performed UMC's first split-liver transplant â
dividing a donor liver between a baby and an adult man. Under his guidance, UMC
became the first hospital in the state to offer liver transplants to children,
and began doing pediatric kidney transplants as well. Molmenti himself performed
liver, kidney and pancreas transplants.
Efforts to contact Molmenti this week were unsuccessful.
Assuming Molmenti's duties as UMC's new chief of abdominal transplants will be
Dr. Rainer Gruessner, recruited here from the University of Minnesota to assume
leadership of UA's entire department of surgery when he arrives in July.
Skilled in liver, kidney, pancreas and intestinal transplants, Gruessner is "a
world-class academic surgeon," Joiner said in announcing his appointment last
month. He is a specialist in living-donor organ transplants, and in minimally
invasive surgery.
Charged with "substantially expanding the size of the department of surgery," as
Joiner put it, Gruessner suddenly will have his hands full on that front. Most
pressing is the immediate need to recruit at least four new trauma surgeons to
fully staff the city's level-one trauma center.
The other two positions in the transplant program will be filled by doctors
within UMC.
"The transplant program will go on," said Judy Dye, the UMC vice president who
oversees the program.
"We are very sorry to lose all three of these physicians, but we expect to see a
smooth transition, especially for our patients. They will continue to get
top-quality care throughout the transplant process."
The sudden loss of a slew of vital UMC physicians, most notably surgeons, "is
all very much coincidence" driven by the needs of the individual doctors and not
by internal dynamics at UA and UMC, Dye said.
"There are completely separate reasons for each of the transplant physicians
leaving. And they have nothing at all to do with the exits of the trauma
surgeons," she said.
When lung-transplant and pediatric heart surgeon Gandy leaves at the end of
June, lung transplants will be performed by Dr. Michael Moulton, currently
performing cardiothoracic surgery at UMC.
Gandy's exit is not just a loss for UMC, but also for the entire Tucson medical
community, now suffering a severe shortage of pediatric specialists. She was the
first specialty-trained pediatric heart surgeon in Southern Arizona and had
planned to open a "center of excellence" for children in the region with
irreversible heart disease.
Gandy could not be reached for comment because she was out of town this week.
Stepping in to oversee the medical care of kidney transplant patients will be
UMC nephrologist Dr. Howard Lien, after James leaves for a position in the San
Francisco area, Dye said.
James joined UMC's kidney-transplant program in 1995 and has served as medical
director since 2001.
Of rumors of internal strife within UMC and its possible effect on physician
decisions, Joiner said, "I don't think there's anything new there. It's not been
any secret about the fact there is stress within the system."
He cited the takeover of the former county hospital, renamed UPH Hospital at
Kino, by University Physicians Healthcare, the doctors' group at UMC, along with
the recent opening of UMC North, the new treatment clinic for the Arizona Cancer
Center, as two major stressors within the UMC/UA system.
"It's taken a situation that's intrinsically difficult â being an academic
health center â and exacerbating it."
On StarNet: For more health news, features and multimedia, check out our health
site at www.azstarnet.com/health
â Contact reporter Carla McClain at 806-7754 or at cmcclain@...
http://www.azstarnet.com/metro/180547

The fear that can haunt police on our streets
30.04.2007
ONE of the Sunshine Coast's top police officers recently spoke candidly
about her concerns many people had lost their respect for members of the
service.
Acting Superintendent Anne Macdonald said she could see a worrying change
in attitude, which was putting her officers in more danger than ever before.
Today a local policeman tells how his life was turned upside down after a
brief but explosive confrontation with one man whose attitude and actions were
indicative of that lack of respect.
It's only a little pain.
A pinch really. Something that seems insignificant in the heat of the
moment.
Certainly not painful enough to send your entire life off its course.
But for anyone who has been the victim of a needle stick injury, that little jab
determines the next six months of their lives.
And for the really unlucky ones, it can completely alter their future.
"It did worry me, not so much for myself, I could deal with it, but I was
worried for my family," recalled the Coast officer who was pricked by a syringe
hidden in the pocket of a man he was arresting.
"During the arrest, it went through his jeans and into my leg. I did feel it but
I didn¡¦t take much notice, I was just trying to restrain him.
"It wasn't until he was searched later and we asked him if he had any sharps in
his pocket that he said *yes* and I reached in and pulled it out. I could see it
was bent, so I knew what had happened.
"I still did my job. I guess I certainly felt ill, annoyed, upset. Sick isn't
the right word, but it certainly made me worried.
"I went straight to the hospital...it's hard because you are not the only person
they have to see, so you have to wait like everyone else."
He was referred to a specialist facility in Nambour where blood tests were taken
and then he and his family could do nothing but wait.
"In the meantime, the offender, who had refused to answer any questions about
whether he had an infectious disease or anything, had been ordered by a
magistrate to have a blood sample taken," he said.
"So I waited for his test to come back and he came back positive for Hepatitis C
and his particular test, it's called a PCR test, came back that he had the
communicable strain of Hep C which meant that I could have contracted it."
That meant blood tests every month for the next six months and an unimaginable
strain on his family.
"I couldn't spend much time with my child, my wife was worried and I was worried
for her and because my name was in the media.
"There were two occasions where I was given a hard time by offenders who were
worried they would catch something from me. It's a life-draining experience.
"The doctor I dealt with was excellent but each test takes 10 or 12 days to come
back and that is a fair wait when you just want answers."
He was given the all-clear after six months but said no one should have to go
through the same ordeal.
"The waiting is the worst. I can't explain it. And it certainly puts a strain on
your household.
"How do you make a three-year-old understand what is going on? Everyone was on
edge, my wife was grumpy that someone outside her family had put her family at
risk.
"The support I received from the community I worked in was overwhelming and I
can't ever thank them enough for their support and the well wishes they gave me
at that time.
"But on a wider scale, the community needs to understand that this is something
that can affect any police officer at any time.
"Police give a lot for their community. There are officers who have lost their
lives for the community and on the scale of things, what happened to me isn't
that bad but if people could just think before they make rash statements about
police officers and what they do and don¡¦t do.
"No one can know how difficult it is until they are in this job."
http://www.sunshinecoastdaily.com.au/localnews/storydisplay.cfm?storyid=3731764&\
thesection=localnews&thesubsection=&thesecondsubsection=

More UK gay men getting hepatitis C
Sat Apr 28, 11:36 AM ET
SUMMARY: Cases rise from one in 110 to one in 83 HIV-positive patients per year;
other men are rarely even screened for the blood-borne disease.
More gay men are getting hepatitis C through sex every year, the 13th BHIVA
Conference heard in Edinburgh, Scotland.
Between 2002 and June 2006, there were 389 cases of recently acquired hepatitis
C in HIV-positive gay men seen in 15 HIV clinics, said Dr. Murad Ruf of
Britain's Health Protection Agency. The clinics serve 85 percent of London's
HIV-positive population.
There were also six cases in HIV-negative men seen in London genito-urinary
medicine clinics.
But whereas all but one of the HIV centers routinely monitors patients for
raised liver function results, which are usually the best sign of hepatitis
infection, only three of London's genito-urinary clinics routinely screen for
hep C, so there could be more infections going undetected.
The number of hepatitis C cases has increased each year. There were 60 in 2002,
77 in 2003, 85 in 2004, 100 in 2005 and 67 in the first six months of 2006.
This means that hepatitis C infections are increasing by one-third more each
year. The overall infection rate in HIV positive men was one infection per 110
clinic patients per year, but by 2006 this had gone up to one infection per 83
patients a year.
The agency's figures don't include information that might rule out other known
causes for hepatitis C infection, such as injecting drugs, but Ruf said that as
few gay men had other major risk factors for hepatitis C, most of it was
probably being acquired sexually.
As hepatitis C is carried in blood rather than semen, the upsurge in hepatitis C
cases has been blamed on fisting, something done by between one in 10 and one in
16 gay men last time the Gay Men's Sex Survey asked about it in 2002.
But Ruf told Gay.com, "It could be any kind of sex where there's trauma to the
mucous membranes -- rough sex, basically."
We don't know if there's something about having HIV that also makes you more
susceptible to hepatitis C, but Ruf pointed out that 85 percent of cases of
lymphogranuloma venereum seen since 2002 were in HIV-positive men and 44 percent
of the syphilis cases seen since 1999.
A study is under way at a clinic in central London to look at cases of hepatitis
C in HIV-negative gay men.
A study from Brighton's genito-urinary clinic last year found five cases of
hepatitis C in HIV-negative men, 16 in pos men, and four in men who were
untested.
The clinic found that men with HIV were 13 times more likely to get hepatitis C
than negative men -- but HIV-negative men were getting it, too.
Once you'd gotten hepatitis C, however, it was a really strong predictor that
you were likely to get HIV soon as well, showing that the risk factors are
similar.
In one London clinic, at St Mary's Hospital in Paddington, 10 of a group of 155
gay men who had become recently infected with HIV went on to get hepatitis C,
too. The average length of time between becoming HIV-positive and hep C-positive
was 17 months.
Five of the 10 had symptoms of acute hepatitis and seven had raised liver
function tests, but three of the infections would have been missed altogether
without careful monitoring for hepatitis C antibodies.
Interestingly, around the time of hepatitis C infection patients had significant
rises in their HIV viral load, showing that the two viruses may have an effect
on each other.
In a study of hepatitis C treatment at the Chelsea and Westminster Hospital,
two-thirds of gay men with recently-acquired hepatitis C responded to treatment
with pegylated interferon and ribavirin and were effectively cured -- but five
patients went on to get second hepatitis C infections.
Out of 118 patients, 14 percent spontaneously cleared their hepatitis C. Of
those offered treatment, three-quarters accepted it.
At north London's Royal Free Hospital, a better cure rate was observed, with 77
percent of recently infected gay men who took hepatitis C treatment responding
to it.
Hepatitis C treatment is hard to tolerate.
In the Chelsea and Westminster study, 30 percent of patients complained of
psychiatric side effects like depression, and 11 percent stopped their treatment
because of them. (Gus Cairns, Gay.com U.K.)

How Bad is Hepatitis C in Erie County?
Posted by: Mike Igoe, Reporter
Created: 4/23/2007 5:32:00 PM
Updated: 4/27/2007 7:56:43 PM
The Town of Hamburg may not welcome this news.
The Erie County Health has started reviewing data on Hepatitis C and found the
town of Hamburg has 19 reported cases since 2005. But Erie County Health
Comissioner Dr. Anthony Bilittier says because the tracking of hepatitis C is
new he's not sure if this is a high number.
Dr. Anthony Bilittier, Erie County Health Commissioner: "It's hard to say what's
normal? What's the background? What do we normlly see in a community? If we have
an outbreak then what's too much?"
Hepatitis C is virus that causes inflammation of the liver. Only certain people
are at risk of contracting it.
Dr. Billittier: "Usually if they don't engage in risky behavior for example IV
drug abuse or unprotected sex with multiple partners, they're not at risk for
Hepatitis C."
Still the county's concerned for the people who are infected. The county health
department says 80% of the people don't show any signs until they become
chronically ill.
Dr. Billittier: "Some people with Hepatitis C will become yellow or jaundiced."
So the County will continue reviewing its data for all communities to try and
get a handle on how bad the Hepatitis C situation really is.
Doctors who see patients with Hepatitis C are required by state law to notify
their local health department.
But part of the challenge the county faces is that people who are at high risk
may not even see a doctor.
http://www.wgrz.com/news/news_article.aspx?storyid=47424

Living with a silent killer
Area residents battle deadly hepatitis C, urge others to be tested
By L.B. WHYDE
Advocate Reporter
NEWARK -- Kyle Morgan has been carrying around a silent killer for many
years and didn't even know it.
Now, after a 48-week regimen of shots, she is hoping the hepatitis C virus
will not return.
Hepatitis C is a virus that affects the liver. Only few indications of the virus
exist, and often no symptoms are present until the liver begins to harden. The
side effects of the treatment are similar to chemotherapy, including fatigue,
flu-like symptoms, skin rashes, hair loss, anemia and irritability. Morgan, 59,
who is the director of academic advising at the Newark campus of Ohio State
University, gave herself shots in the stomach once per week. Although she is not
sure how she contracted the virus, the blood transfusion she received when she
was 1 year old might have been the source of the contamination.
"I feel like I lost a year of my life," Morgan said. "It's been a nightmare (the
treatments). I've been off the medicine a week, and I feel better already."
Hepatitis C is called the silent killer because of the lack of symptoms before
the liver becomes hardened.
When it was discovered in a routine blood test in 2001, Morgan's hepatitis C was
in stage 1. She was given the choice whether to treat the virus. After research
and an online support group, Morgan decided against the treatment. Two years
later, another biopsy was done; again, she denied treatment.
Then in 2006, after another biopsy, the doctors found the virus in stage 2 and
told her she couldn't wait any longer to treat. After the seventh week of
treatment, a test found the virus undetectable, but she still had to continue
the 48-week regimen.
"The worst part of the treatment was during the last few months, I slept my
weekends away, and I lost half my hair," Morgan said. "But I was able to work
the whole time, and many cannot do that."
Morgan now will have to wait six months before she can find out if she is free
of the virus.
John Eskins, 55, of Glenford, has been living with hepatitis C for many years
but thinks he may have contracted it in 1969 when he served in the Army as a
medic and came in contact with blood from a lot of people. In 1980, he felt run
down and during a physical they found non A and non B chronic active hepatitis.
This was before hepatitis C was named as a specifically different form of the
virus. Now hepatitis is like "alphabet soup" said Eskins, because there even is
a hepatitis G.
At one time several years ago, Eskins was on a liver transplant waiting list for
four years. He was called in for a transplant twice, but both times the liver
was not acceptable. He now has learned to live with the virus but still has his
good days and his bad days. Now, his doctors don't even tell him his life
expectancy, because he continues to outlive their projections.
"I improved," Eskins said. "I still have problems as I sleep a lot, get sick a
lot and have trouble with my memory, but the liver is still there working,
barely. Personally, I believe God helped me a lot on this."
While Eskins and Morgan and the millions of other people that carry the virus in
their blood might not look sick, hepatitis C still is life-threatening.
"I just want to get the word out to people," Morgan said. "If they have the risk
factors, they need to get their blood tested."
L.B. Whyde can be reached at (740) 328-8513 or lwhyde@...
http://www.newarkadvocate.com/apps/pbcs.dll/article?AID=/20070429/NEWS01/7042903\
14/1002/NEWS01

Transplant of HBV-infected kidney blamed for death
The Yomiuri Shimbun
A man who received a kidney from a hepatitis B-positive donor at Uwajima
Municipal Hospital in Uwajima, Ehime Prefecture, later became infected with the
virus, resulting in his death due to liver failure and acute pancreatitis, the
hospital's inspection committee announced Sunday.
The committee revealed the case in the final report on cases where doctor Makoto
Mannami, who currently works at Uwajima Tokushukai Hospital in the city,
transplanted diseased kidneys at Uwajima Municipal Hospital while working at the
hospital.
Committee Chairman Katashi Fukao, director of Chiba Rosai Hospital in Ichihara,
Chiba Prefecture and former director of the Japan Society for Transplantation,
strongly criticized the transplants conducted by Mannami, saying: "It was highly
likely that the recipient got infected [with the hepatitis B virus] through the
transplant. It is also difficult to deny that the transplant caused his death.
The transplant was fundamentally reckless and cannot be regarded as treatment."
The committee concluded in the final report that all 20 cases in which diseased
kidneys were removed for transplant, and 25 cases in which diseased kidneys were
transplanted, were inappropriate.
The patient's blood tested positive for hepatitis B surface antigen 10 days
before the removal of the kidneys, meaning the HBV was inside the patient's
body.
A man in Uwajima received one of the patient's kidneys. It was the third time
for him to receive a kidney transplant following previous transplants from his
father and mother.
However, because the transplanted kidney did not function properly, it was
removed about a week later.
In March 2001, he received a fourth kidney, taken from a person suffering from
kidney cancer, but he developed liver failure in May that year and died of acute
pancreatitis the following month at the age of 29. The man's blood tested
positive for hepatitis B surface antigen.
In the case of another recipient of a kidney from the same donor who tested
positive for HBV, the kidney did not function properly and was removed two weeks
after the transplant. The recipient has not been infected with HBV, according to
the committee.
Fukao said the deceased patient was highly likely to have become infected with
HBV through the transplant because it was difficult to consider any other likely
sources of infection.
"The patient was an innocent victim of a transplant of a kidney that rarely
functioned from the beginning," Fukao said. "It was a transplant that should
never have been carried out."
(Apr. 30, 2007)
http://www.yomiuri.co.jp/dy/national/20070430TDY01003.htm

Committee for Medicinal Products for Human Use Post-authorisation Summary of
Positive Opinion for Viraferonpeg
International Nonproprietary Name (INN): peginterferon alfa-2b
LONDON, April 26, 2007-On 26 April 2007 the Committee for Medicinal Products for
Human Use (CHMP) adopted a positive opinion** to recommend the variation to the
terms of the marketing authorisation for the medicinal product ViraferonPeg. The
Marketing Authorisation Holder for this medicinal product is Schering-Plough
Europe.
The CHMP adopted a new indication as follows:
ViraferonPeg is indicated for the treatment of adult patients with chronic
hepatitis C who have elevated transaminases without liver decompensation and who
are positive for serum HCV-RNA or anti-HCV, including naïve patients with
clinically stable HIV co-infection (see section 4.4).
For information the full indication of ViraferonPeg will be as follows:
ViraferonPeg is indicated for the treatment of adult patients with chronic
hepatitis C who have elevated transaminases without liver decompensation and who
are positive for serum HCV-RNA or anti-HCV, including naïve patients with
clinically stable HIV co-infection (see section 4.4).
The best way to use ViraferonPeg in this indication is in combination with
ribavirin. This combination is indicated in naïve patients as well as in
patients who have previously responded (with normalisation of ALT at the end of
treatment) to interferon alpha monotherapy but who have subsequently relapsed.
Interferon monotherapy, including ViraferonPeg, is indicated mainly in case of
intolerance or contraindication to ribavirin. Please refer also to the ribavirin
Summary of Product Characteristics (SPC) when ViraferonPeg is to be used in
combination with ribavirin.
The CHMP adopted a new contraindication as follows:
- Initiation of ViraferonPeg is contraindicated in HCV/HIV patients with
cirrhosis and a Child-Pugh score ? 6.
For information, the full contraindication for ViraferonPeg will be as follows:
- Hypersensitivity to the active substance or to any interferon or to any of the
excipients;
* Summaries of positive opinion are published without prejudice to the
Commission Decision, which will normally be issued within 44 days (Type II
variations) and 67 days (Annex II applications) from adoption of the Opinion.
** Marketing Authorisation Holders may request a re-examination of any CHMP
opinion, provided they notify the EMEA in writing of their intention to request
a re-examination within 15 days of receipt of the opinion.
- A history of severe pre-existing cardiac disease, including unstable or
uncontrolled cardiac disease in the previous six months (see section 4.4);
- Severe, debilitating medical conditions;
- Autoimmune hepatitis or a history of autoimmune disease;
- Severe hepatic dysfunction or decompensated cirrhosis of the liver;
- Pre-existing thyroid disease unless it can be controlled with conventional
treatment;
- Epilepsy and/or compromised central nervous system (CNS) function;
- Initiation of ViraferonPeg is contraindicated in HCV/HIV patients with
cirrhosis and a Child-Pugh score ? 6.
Combination therapy with ribavirin: Also see ribavirin Summary of the Product
Characteristics (SPC) if ViraferonPeg is to be administered in combination with
ribavirin in patients with chronic hepatitis C.
Detailed conditions for the use of this product will be described in the updated
Summary of Product Characteristics (SPC) which will be published in the revised
European Public Assessment Report (EPAR) and will be available in all official
European Union languages after the variation to the marketing auth