New liver transplant guidelines improve odds for patients in Northeast
Dr. Adel Bozorgzadeh chief of the Division of Organ Transplantation at UMass Memorial Medical Center - University Campus in Worcester, discusses what changes in organ transplant rules will mean for patients locally. [T&G Staff/Steve Lanava]

​By Susan Spencer 
Telegram & Gazette Staff 

Posted Jan 31, 2019 at 6:00 PMUpdated Jan 31, 2019 at 6:00 PM
  WORCESTER - For 30 years, the chance that someone who needed a liver transplant would actually get an appropriate liver in time depended at least as much on geography as on how sick the patient was.
But under a policy change approved in December by the board of directors of the Organ Procurement and Transplantation Network/United Network for Organ Sharing, patient severity of illness will weigh more heavily in allocating available organs to waiting patients.
As a result, after the policy change goes into effect April 30, patients with end-stage liver disease in places such as New England and New York, which have a lower supply of available organs relative to the need, will fare better than under the current rules.
“This really has been a long overdue change,” said Dr. Adel Bozorgzadeh, chief of the division of organ transplantation at UMass Memorial Medical Center.
UMass Memorial has been a center for liver transplants since the 1990s. In 2018, 66 liver transplants were performed there, according to U.S. Health and Human Services data.
There were 274 liver transplants in Massachusetts last year, out of 8,250 performed nationwide.
Dr. Bozorgzadeh said, “These new rules are going to level the playing field. Hopefully it’s going to decrease the risk of waitlist mortality, so that really is different.”
The current long-standing distribution policy grew out of enactment of the National Organ Transplant Act in 1984, which was passed to address the nation’s critical organ donation shortage and improve the organ matching and placement process.
The law established the Organ Procurement and Transplantation Network, which maintains a national registry for organ matching. OPTN contracts with the nonprofit United Network for Organ Sharing, or UNOS, to operate the matching network.
The policy was based on 11 geographic regions set up across the country. Because organs from deceased donors can only be kept alive and usable for a few hours - it’s about 10 hours for livers - the idea was to place available organs with the closest patients in need.
The expectation was that the incidence of disease and availability of organs would match, Dr. Bozorgzadeh said. “In reality, over the next three decades we would see nothing farther from the truth.”
He said patients would be gravely ill in intensive care units at UMass Memorial or other transplant centers in the region, but no liver would be available. At the same time, someone in Pittsburgh or Indiana, for example, who was only half as sick, would get a liver.
“There’s a significant strain on our population,” Dr. Bozorgzadeh said.
The reasons for the mismatch reflect geographic differences in population age and causes of death, according to Dr. Bozorgzadeh.
TO CONTINUE STORY: https://www.telegram.com/news/20190131/new-liver-transplant-guidelines-improve-odds-for-patients-in-northeast

December 19, 20185:00 AM ET
​MICHELLE ANDREWS



When people seek help at a drug treatment center for an opioid addiction, concerns about having contracted hepatitis C are generally low on their list.
They've often reached a crisis point in their lives, says Marie Sutton, the CEO of Imagine Hope, a consulting group that provides staff training and technical assistance to facilitate testing for the liver-damaging virus at more than 30 drug treatment centers in Georgia.
"They just want to handle [their drug problem]," Sutton says. "Sometimes they don't have the bandwidth to take on too many other things."
And although health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen.

SHOTS - HEALTH NEWSTreating Prisoners With Hepatitis C May Be Worth The Hefty PriceIt's an enormous missed opportunity, say public health specialists.
"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, president and CEO of the American Liver Foundation. "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."
As the number of people who inject drugs has soared, the rate of infection with hepatitis C — which is frequently tied to sharing needles — has climbed steeply, too.
People with a hepatitis C infection can go for years without symptoms, so may have no inkling they're sick. That delayed onset makes screening important, say health researchers, since infected people may unwittingly infect others.
Still, while screening people who misuse drugs can break the cycle of transmission, public health advocates say a number of obstacles — a lack of money, staff or other resources — may keep substance abuse facilities from going that route.
​TO CONTINUE READING: https://www.npr.org/sections/health-shots/2018/12/19/676417852/why-arent-more-

December 19, 20185:00 AM ET MICHELLE ANDREWS

When people seek help at a drug treatment center for an opioid addiction, concerns about having contracted hepatitis C are generally low on their list.
They've often reached a crisis point in their lives, says Marie Sutton, the CEO of Imagine Hope, a consulting group that provides staff training and technical assistance to facilitate testing for the liver-damaging virus at more than 30 drug treatment centers in Georgia.
"They just want to handle [their drug problem]," Sutton says. "Sometimes they don't have the bandwidth to take on too many other things."
And although health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen.

SHOTS - HEALTH NEWSTreating Prisoners With Hepatitis C May Be Worth The Hefty PriceIt's an enormous missed opportunity, say public health specialists.
"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, president and CEO of the American Liver Foundation. "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."
As the number of people who inject drugs has soared, the rate of infection with hepatitis C — which is frequently tied to sharing needles — has climbed steeply, too.
People with a hepatitis C infection can go for years without symptoms, so may have no inkling they're sick. That delayed onset makes screening important, say health researchers, since infected people may unwittingly infect others.
Still, while screening people who misuse drugs can break the cycle of transmission, public health advocates say a number of obstacles — a lack of money, staff or other resources — may keep substance abuse facilities from going that route.

​TO CONTINUE READING: https://www.npr.org/sections/health-shots/2018/12/19/676417852/why-arent-more-users-of-opioids-or-meth-screened-for-hepatitis-c

​DECEMBER 16, 2018
Jared Kaltwasser MD Magazine

One-third (32%) of people who contract hepatitis C virus (HCV) as a child will go on to develop cirrhosis at a median of 33 years post-infection, according to new research.

The study, highlighting the importance of testing and early intervention in young patients with HCV, helps clinicians quantify the means by which infection is occurring in children.

Investigators from Birmingham Women and Children’s Hospital and Nottingham University Hospital NHS Trust analyzed data from the HCV Research UK database, finding 1049 enrollees who were diagnosed with HCV as a child. They found that most of the patients had contracted the virus through the use of intravenous drugs (52%), and the next-largest category contracted the disease via blood products (24%). Another 11% contracted the virus through perinatal infection.

William L. Irving, PhD, a professor of virology at the University of Nottingham, said he was surprised to see that liver disease appears to progress at the same rate regardless of whether the person is infected at an advanced age, or at birth.

“There would be reasons for thinking this might not be true, because those individuals [infected at birth] would not have the same co-factors for disease progression as older children and adults, most obviously alcohol consumption,” he told MD Magazine®, “and yet for the small numbers of cases that we were able to follow, cirrhosis developed at roughly the same interval after infection as it did for the children who acquired infection through drug use.”

Among the patients enrolled in the study and diagnosed in childhood, 663 patients received treatment and three-quarters of those achieved sustained virological response (SVR). Of those receiving treatment, 55% were given interferon/Peg interferon therapy, and 40% were given direct-acting antivirals (DAAs).

Achieving SVR was shown to be a significant milestone in terms of later health outcomes. Mortality rates among patients achieving SVR was just 1%, versus 5% for patients without SVR.

Line Modin, MD, PhD, who at the time was at Birmingham Women and Children’s Hospital but who now works at the Hans Christian Andersen Children’s Hospital, in Denmark, noted that regulators in the US and Europe have approved certain HCV therapies for children. Sofosbuvir and ribavirin were approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) earlier this year for the treatment of children ages 12-17. The EMA has also approved ledipasvir/sofosbuvir (Harvoni) for children over 12.

However, she noted that that approval has not yet translated into access everywhere in Europe.

TO CONTINUE READING:
​https://www.mdmag.com/medical-news/young-people-with-hepatitis-c-face-cirrhosis-at-younger-age

Public Health
​·  ·  ·  December 6, 201812:36 AM ET
Elana Gordon 

​

The U.S. drug crisis does not appear to be letting up. The nation experienced a shattering 47,000 opioid-related overdose deaths in 2017.
Driving the surge are potent, cheap synthetics like fentanyl that have spread into the illicit drug supply. In response, communities have been trying a range of interventions, from increasing the availability of the antidote naloxone to upping treatment resources.
But an analysis released Thursday by the Rand Corporation, a policy think tank, concludes it's time to pilot an approach from outside the U.S.: offering pharmaceutical-grade heroin — yes, heroin — as a form of treatment for longtime heroin users who haven't had success with other treatments. It's already happening in several European countries and Canada. But prescribing heroin would challenge culture, laws and practice in the U.S.
"These are controversial interventions," says lead author Beau Kilmer, who co-directs RAND's drug policy research center. "There are some people that don't even want to have conversations about this. But given where we are with opioid deaths near 50,000 and fentanyl deaths near 30,000, it's important that we have discussions about these interventions that are grounded in the research and grounded in the experiences of other countries."
​Here's how programs that offer prescription heroin, or heroin-assisted treatment, work. Patients typically get a regular, measured dose of pharmaceutical-grade heroin — also known as diacetylmorphine or diamorphine — and inject it under close medical supervision inside a designated clinic. The idea is if people have a legal source of heroin, they'll be less likely to overdose on tainted street drugs, spend less time and energy trying to get their next fix, and instead be able to focus on the underlying drivers of their addiction.
"This is just another treatment that could help stabilize lives,"says Kilmer.
It's not meant for everyone. Medications like methadone, buprenorphine and naltrexone are highly effective treatments that function in different ways to address cravings and withdrawal symptoms or block the effects of drugs. But these first-line treatments don't work for some longtime opioid users. In Canada's main study of prescription heroin, eligible patients had already tried quitting heroin an average of 11 times.
Prescription heroin as a form of maintenance therapy dates back to the early 1920s in the UK, and revved up in the 1990s in other parts of Europe. (It was even allowed in the U.S. before the sweeping federal drug laws of the early 20th century.)
Heroin-assisted treatment is different from the concept of supervised consumption sites, where patients bring their own illicit drugs and then inject them while medical staff are present, ready to respond in case of an overdose. These are increasingly debated in the U.S. as at least a dozen cities consider them.
Kilmer says prescription heroin has been researched with more rigorous methods. Several randomized controlled trials in Canada, the United Kingdom and the Netherlands found that people addicted to heroin benefited from the approach, according to RAND's analysis. They were more likely to stay in treatment compared with those who took methadone, and they were less likely to revert to using illicit heroin. Evidence also suggests that prescription heroin may be more effective than methadone in reducing criminal activity and improving patients' physical and mental health.
For Dr. Chinazo Cunningham, an addiction specialist at Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, alternative approaches are important, but she thinks it's more imperative in the U.S. to focus on what she sees as the most pressing issue right now: "We have treatment that works, we just need to provide it in a way that is accessible to people," she says.
As it stands, a vast majority of people who could benefit from first line treatments for opioid use disorder aren't getting it, a problem that's even driving a black market for treatment.
"It's hard for me to imagine heroin-assisted treatment because I think right now even talking about getting more mainstream treatment like methadone, buprenorphine and naltrexone to people, there's already so much stigma around it," says Cunningham.
As part of the analysis, RAND conducted focus groups and interviews in several New Hampshire and Ohio counties hit hard by the overdose crisis. The idea of prescription heroin was new to many and was met with skepticism over its acceptability from health professionals, local leaders, and those in treatment. People worried that heroin-assisted treatment "would enable drug use" and face community resistance.

​Elana Gordon is a health reporter and a 2018-2019 Knight Science Journalism Fellow at MIT. You can follow her on Twitter: @elana_gordon.

TO CONTINUE READING:https://www.npr.org/sections/health-shots/2018/12/06/673986164/is-america-read

Embargoed Until: Media Contact:
November 6, 2018 10 a.m. Eastern National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention
(404) 639-8895
NCHHSTPMediaTeam@cdc.gov

CDC Estimates Nearly 2.4 Million Americans Living with Hepatitis C
New data highlight urgent need to diagnose and cure more Americans, and to address rising infections due to U.S. opioid crisis
Nearly 2.4 million Americans – 1 percent of the adult population – were living with hepatitis C from 2013 through 2016, according to new CDC estimates published today in the journal Hepatology.
Medications that cure hepatitis C offer the hope of eliminating the disease in the U.S., yet, today’s report suggests that millions are infected and have not benefited from these new treatment options. Expanded testing, treatment, and prevention services are urgently needed, especially in light of the surge in new infections linked to the opioid crisis.
“Every American who has been cured of hepatitis C is living proof that ending this epidemic is possible,” said CDC Director Robert R. Redfield, M.D. “Hundreds of thousands of Americans have already been cured. In order to achieve our goal, we must commit to ensuring that everyone living with hepatitis C is tested and treated.”
To estimate total hepatitis C prevalence in the United States, researchers analyzed blood test results from the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2013 through 2016. They also analyzed data from other studies of groups not surveyed in the NHANES, including active duty members of the military, and people who are incarcerated or homeless.
Opioid crisis puts new generations at risk of hepatitis C infections
Adding to the burden of those already living with hepatitis C, separate CDC surveillance data indicate that the number of new infections each year in the United States is disturbingly high and on the rise. Acute hepatitis C cases reported to CDC more than tripled from 2010 to 2016, with most new hepatitis C infections due to increased injection drug use associated with the nation’s opioid crisis. Based on these data, CDC estimates that more than 41,000 Americans were newly infected with hepatitis C in 2016 alone.
“Seeing an undiagnosable infection become a curable disease has been a public health highlight of the past 30 years. But the shadow of the opioid crisis puts our nation’s progress at risk,” said Jonathan Mermin, M.D., director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Tackling hepatitis C requires diagnosing and curing people living with the virus and cutting off new infections at the source.”
Hepatitis C affects nearly every generation
Hepatitis C now poses a serious health threat to three generations of Americans, all of whom need to be reached with prevention services, testing, and treatment:
 Baby boomers (born between 1945 and 1965) account for a large portion of all chronic hepatitis C infections in the United States and currently have the highest rate of hepatitis C-related deaths. CDC recommends that all adults born between 1945 and 1965 get a one-time test for hepatitis C, but only a small fraction have done so.
 Adults under 40 have the highest rate of new infections, largely because of the opioid crisis.
 Infants born to mothers with hepatitis C are a growing concern. The overall risk of an HCV-infected mother transmitting infection to her infant is approximately 4 percent to 7 percent per pregnancy. From 2011 through 2014, national laboratory data indicate that the rate of infants born to women living with hepatitis C increased by 68 percent.
Eliminating hepatitis C requires substantial national commitment
Even though new treatments can cure hepatitis C virus infections in as little as two to three months, far too many Americans have not been effectively treated. They may be unaware of their infection or they are unable to access medication because they lack healthcare coverage or have financial restrictions.
In addition to expanding testing and removing barriers to treatment, authors of the new report stress that intensified programs to prevent, track, and respond to new hepatitis C infections are also essential to reducing the number of infections. Prevention efforts to address new infections include support for comprehensive community-based prevention services. Such services focus on drug treatment and recovery and reducing transmission of viral hepatitis and HIV through hepatitis A and B vaccination, testing, linkage to care and treatment, and access to sterile syringes and injection equipment.
“Until we as a nation remove the barriers to hepatitis C testing and treatment, it will continue to cost us dearly – both in terms of dollars and American lives,” said Dr. Mermin. “Every death from hepatitis C is a reminder of a promise not yet realized for far too many.”
For more information visit: www.cdc.gov/nchhstp/newsroom.
###
CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Marvin Jackson, 70, has been an avid tennis player for most of his life. When he noticed that his urine was a deep brown color, he wrote it off as a symptom of dehydration.
Then, in 2012, Jackson, who is African American, learned from his doctor that his dark urine was actually a sign that he had hepatitis C. Hepatitis C is a serious infection that affects the liver but can have few symptoms.
Unhappy with his doctor’s bedside manner, he delayed returning for a follow-up after his diagnosis. When he did return, he got another stunning diagnosis from a different doctor.
“He says, ‘Marvin, you’ve got liver cancer,’” Jackson recalled. Untreated hepatitis C is one of the causes of the illness. “Before I get a chance to let it all sink in, he’s telling me what we’re gonna do.”
Jackson had a liver transplant in 2013. Recovery has been a challenge, he said, but now he’s reached a “new normal.”
African American and Latinos Face Increased Rates of Liver Cancer, Higher Death Risk
Jackson’s case is not uncommon. People of color have long had higher rates of liver cancer, and data recently released by the Centers for Disease Control (CDC) suggests that the disparity persists.
The study, released in July, showed that death rates for liver cancer in adults (aged 25 and up) increased by 43 percent between 2000 and 2016.
Researchers also found sharp disparities in death rates by race. The rate for non-Latino whites was 9 per 100,000. Asian and Pacific Islanders (APIs) and African Americans both had death rates of 13.6 per 100,000. Latinos had the highest death rates of 14.6 per 100,000.
While they remain high, death rates among APIs have dropped significantly since 2000, when the rate was 17.5.
In California, liver cancer incidence and death rates have also declined among APIs since 2000. Yet rates among Latinos and African-Americans have increased over that same period, according to data from the California Cancer Registry.
Just over half of liver cancer cases arise from well-established risk factors, like viral hepatitis, cirrhosis, and non-alcoholic fatty liver disease, according to Salma Shariff-Marco, a UCSF professor who works on the Greater Bay Area Cancer Registry. Researchers, health care professionals and advocates are doing their best to screen, prevent and treat for those risk factors.
TO CONTINUE: http://www.calhealthreport.org/2018/10/25/people-color-face-higher-rates-hep-c-deadly-cases-liver-ca

Governor Andrew M. Cuomo today announced the members selected to join the Task Force that will advise the state on its Hepatitis C Elimination Plan. The creation of the Task Force is the next step toward finalizing the Elimination Plan and builds on recommendations presented by community stakeholders at the New York State Hepatitis C Elimination Summit in 2017.
"The members selected for this task force are some of the finest in their fields, and their invaluable experience will provide us with the information we need to develop an attainable elimination plan," Governor Cuomo said. "This strategic plan will not only improve the quality of life for those living with Hepatitis C, but also ensure that New Yorkers have the support and resources they need to prevent this disease."
"Our comprehensive approach to eliminating Hepatitis C will help to save lives and bring peace-of-mind to millions of New Yorkers," said Lieutenant Governor Kathy Hochul. "Like so many other issues, New York is leading the nation, and developing a new approach to combating this deadly disease. The Task Force will bring together the best and the brightest to focus on creative solutions, helping to improve the health of New Yorkers and ensure Hepatitis C becomes a concern of the past."
The work of the Task Force will be supplemented by five workgroups: Prevention; Testing and Linkage to Care; Care and Treatment; Surveillance, Data and Metrics; and Social Determinants. Task Force and workgroup members include representatives from community based organizations, people living with and affected by hepatitis C, health care providers, payers, public health experts, researchers, harm reduction specialists and social service providers.
In March, Governor Cuomo announced New York State's commitment to eliminate hepatitis C by increasing access to testing, treatment and education in order to connect New Yorkers in high-risk communities with available services. In July, the Governor outlined his strategy for hepatitis C elimination, which included the allocation of $5 million for hepatitis C services, such as education; patient navigation; care and treatment programs in harm reduction settings; removal of insurance barriers; expansion of hepatitis C treatment capacity; Medicaid reimbursement for harm reduction services; and the expansion of syringe exchange access.
More than 100,000 New Yorkers are living with Hepatitis C—a liver disease caused by the hepatitis C virus—and most are unaware that they have it. Three out of four people living with hepatitis C are baby boomers. Hepatitis C is spread by blood to blood contact, with the most common risk factor for hepatitis C being injection drug use. Over the past decade, there has been a shift in the distribution of hepatitis C cases, with a distinct peak emerging among younger people aged 20 to 40, which has been fueled in part by the growing opioid epidemic. 
Left untreated, hepatitis C causes cirrhosis and liver failure, resulting in liver transplant, liver cancer or death. New available treatments can cure almost all patients in just 12 weeks. The expansion of harm reduction services, outlined in the Governor's plan, will help stop hepatitis C transmission among people who inject drugs.

TO CONTINUE AND SEE TASK FORCE MEMBERS: https://www.governor.ny.gov/news/governor-cuomo-announces-selection-hepatitis-c-elimination-task-force-members

​Experts have designed and validated models to predict the risk of hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV) following antiviral treatment, according to new research published in the Journal of Hepatology.

Researchers have developed an online calculator that estimates an HCV-infected patient’s risk for hepatocellular carcinoma after antiviral treatment.From these models, the researchers designed an online calculator, now available at www.hccrisk.com, that estimates a patient’s HCC risk after treatment.
“It is important that we can model the risk of hepatocellular carcinoma in these patients, so that we develop the optimum screening strategy that avoids unnecessary screening, while adequately screening those at increased risk,” wrote authors led by George N. Ioannou, MD, MS, Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Healthcare System, University of Washington, Seattle, WA.
Most Americans with chronic HCV are now treated with direct-acting antivirals (DAAs) for 3 to 5 years. This treatment eradicates HCV in the majority of these patients, with sustained virologic response (SVR) rates exceeding 90%. After achieving SVR, the risk of HCC is significantly reduced.
“It follows that HCC risk needs to be estimated specifically for the period following antiviral treatment, incorporating whether SVR was achieved or not, and that previous models predicting HCC risk in untreated HCV-infected patients do not apply to patients who have undergone antiviral treatment,” the authors wrote.
Although current guidelines call for screening HCV-infected patients with cirrhosis, there is no such mandate for non-cirrhotic HCV-infected individuals, despite the HCC risk. This “one-size-fits-all” strategy is problematic in the age of DAA treatment and, according to the authors, requires improvement.

​TO CONTINUE READING:   https://www.mdlinx.com/infectious-disease/article/2770

YALE MEDICINE
By JENNY CHEN OCTOBER 26, 2017

Yale Medicine experts share opinions on common misconceptions that may be preventing people from getting help.
Between 2015 and 2016, drug overdose deaths went from 33,095 to 59,000, the largest annual jump ever recorded in the United States. That number is expected to continue unabated for the next several years. We talked to a panel of Yale Medicine experts who weighed in on the three most harmful and widely held misconceptions that are preventing large groups of people from getting treatment

Myth #1: Opioid addiction is just a psychological disorder and people who are dependent simply need better willpower.  Richard Schottenfeld, MD, Psychiatry

​It’s important to define opioid addiction carefully, because the stigma is so strong. Someone who is prescribed opioid medications for pain for prolonged periods may develop tolerance, which means they need a higher dose to get pain relief. Or they may experience withdrawal symptoms when they stop taking the medication. But these are not considered cases of opioid addiction.
Opioid addiction, or technically “opioid use disorder,” is defined as loss of control over use of opioids. This means that the person continues to use opioids despite negative consequences or is unable to stop using opioids despite wanting to. This person may also have a preoccupation with using opioids, obtaining opioids or craving for opioids. These patients may also develop tolerance or experience withdrawal when they stop using, but those symptoms by themselves do not define an opioid use disorder.
Some people think that an opioid addiction is just psychological or a weakness of character, and that people who are addicted simply don’t have the willpower to stop. But it’s more complicated than that. Long-time use of opioids in an addictive way actually alters brain functioning. It causes chronic and lasting changes in the brain reward system, causing the person to feel less motivation and get less pleasure from other, naturally occurring rewards. Opioids become the primary reward and the primary focus of the person’s life, and they need more of it to activate the reward system.

TO CONTINUE READING: https://www.yalemedicine.org/stories/opioid-addiction-myths/