The experience of fatigue for people living with hepatitis C

Hepatitis C affects approximately 3% of the world population, with fatigue being acknowledged as the cardinal symptom. Despite growing recognition that hepatitis C fatigue impacts in a negative manner on quality of life, at the time of this study no empirical information existed regarding the nature of this fatigue or the way in which it affects a person's life. Such information is needed to enable nurses to engage in appropriate sensitive symptom management which is the core nursing activity with this population, as to date there is no vaccine or widely effective pharmacological therapy. The aim of the study was to ascertain the nature of hepatitis C fatigue. A qualitative approach using a grounded theory approach was employed. Theoretical sampling generated 28 participants for in-depth interview. Data analysis consisted of three coding processes, each type of coding having its own purpose and method. Ethical approval was obtained, both from the principal author's academic institution and the participating health care institution. Hepatitis C fatigue emerged as being multidimensional in nature, with both acute and chronic versions existing. The hepatology community is beginning to acknowledge the significant prevalence of hepatitis C fatigue. This study provides a valuable insight into its nature. This information can serve as resource for practitioners in their development of interventions to enable the hepatitis C virus population live with fatigue in a proactive manner.     

Transfusion-acquired hepatitis C: the Danish lookback experience. The Danish HCV [hepatitis C virus] Lookback Group

BACKGROUND: In 1996, the Danish National Board of Health recommended hepatitis C virus (HCV) lookback to identify recipients of blood components from donors found to be positive since the implementation of anti-HCV screening in 1991. STUDY DESIGN AND METHODS: The aim was to accumulate results of the lookback at a national level and to describe the morbidity of the infected recipients. Records of transfusion were identified for at least 10 years back, and recipients still alive were tested for hepatitis C.Those with positive results were referred for clinical evaluation. RESULTS: A total of 150 anti-HCV-positive Danish donors had donated blood to 1018 transfusion recipients, of whom 288 (29%) were still alive. Because of age, malignancy, or other severe diseases, 118 (41%) of these were not contacted. Of 157 recipients screened for HCV, 128 (82%) were anti-HCV positive on enzyme-linked immunosorbent assay, and 88 (56%) were HCV RNA positive. Among the HCV RNA-positive recipients, symptoms were present in 38 percent (25/66 reported), elevated alanine aminotransferase was found in 53 percent (41/77 tested), and cirrhosis was found in 11 percent (6/54 biopsied). Treatment with interferon alpha was initiated in 23 patients, corresponding to 26 percent of HCV RNA positive recipients. CONCLUSION: Among tested recipients in the Danish HCV lookback, most were anti-HCV positive and more than half were still viremic. The morbidity was considerable, and one-fourth of viremic recipients entered treatment.     

Challenges in the treatment of chronic hepatitis C in the HIV/HCV-coinfected patient

Hepatitis C virus (HCV) and HIV are common coinfections that convey a shortened lifespan, mostly related to liver disease. Treatment against HCV in the coinfected patient is notoriously more complex and challenging. There are no optimal treatment algorithms for HIV/HCV coinfected patients as efficacy of approved anti-HCV therapies is low with relevant side effects. The use of direct-acting antivirals for anti-HCV therapy has the potential to improve therapeutic efficacy, but also increase side effects and drug–drug interactions. In spite of all of this, the most important and significant fact is that chronic hepatitis C is potentially curable, and the eradication of the HCV infection is a crucial outcome in this population. The establishment of a productive collaboration among the regulatory agencies, the medical community and the pharmaceutical industry could lead to faster access to more effective HCV therapies for the coinfected patient and eventually stop the progression of liver disease in these patients.     

Improvements in protein PEGylation: pegylated interferons for treatment of hepatitis C.

Poly(ethyleneglycol) or PEG has proven to be of great value for a range of biomedical applications. A review the properties of PEG that lead to these applications is reported. Emphasis is placed on pharmaceutical uses of PEG--proteins, with specific discussion of the attributes of PEGylated alpha-interferon for treatment of hepatitis C. In this latter case the choice of PEG reagent is critical to the properties of the drug, and therefore a brief presentation of PEG reagents for protein PEGylation will be given. PEGylation chemistries can be divided into first- and second-generation approaches. The first-generation chemistries are generally restricted to low-molecular-weight methoxy-PEGs because of the problem of diol contamination and resulting difunctional reagents. Problems with weak linkages and side reactions are also encountered. Second-generation PEGylation reagents avoid weak linkages and side reactions. Also they can be purified to remove diol contaminants, and as a consequence, high-molecular-weight PEGs can be used. These relatively simple chemical advances have given new vigor to PEGylation as a technology. The benefits of using high-molecular-weight, second-generation PEG reagents are demonstrated by using PEG--alpha-interferon as an example. In this case it is observed that a greatly improved drug is provided for treatment of hepatitis C.     

Thymalfasin for the treatment of chronic hepatitis C infection

Approximately 50% of treatment-naive hepatitis C patients fail to achieve a sustained virologic response with standard peginterferon and ribavirin therapy. Patients who are infected with genotype 1 have high viral loads and are nonresponders to previous therapy, and are even more difficult to treat, underscoring the need for new therapeutic options. Thymalfasin (thymosin-alpha1), in combination with peginterferon-alpha2a, has demonstrated efficacy among difficult-to-treat patients with hepatitis C. The addition of ribavirin to thymalfasin and peginterferon-alpha2a has also exhibited promising results among patients who have genotype 1 hepatitis C, high viral loads and are nonresponders to previous therapy.     

Thymalfasin for the treatment of chronic hepatitis C infection

Approximately 50% of treatment-naive hepatitis C patients fail to achieve a sustained virologic response with standard peginterferon and ribavirin therapy. Patients who are infected with genotype 1 have high viral loads and are nonresponders to previous therapy, and are even more difficult to treat, underscoring the need for new therapeutic options. Thymalfasin (thymosin-α₁), in combination with peginterferon-α_2a, has demonstrated efficacy among difficult-to-treat patients with hepatitis C. The addition of ribavirin to thymalfasin and peginterferon-α_2a has also exhibited promising results among patients who have genotype 1 hepatitis C, high viral loads and are nonresponders to previous therapy.     

Telaprevir for the treatment of chronic hepatitis C infection

Telaprevir is an NS3/4A protease inhibitor that has recently received US FDA approval for the treatment of chronic HCV infection. Telaprevir is given in combination with peg-IFN-α and ribavirin and is indicated for both treatment-naive and treatment-experienced patients with genotype 1 infection. Along with the other first generation NS3/4A protease inhibitor boceprevir, these combination regimens have immediately become the standard of care for genotype 1 patients. The adverse event profile for the combination regimen remains dominated by peg-IFN-α and ribavirin, but there is additional anemia and rash with telaprevir. Owing to telaprevir’s metabolism by the CYP3/4A pathway, drug–drug interactions could lead to toxicity from other medications or decreased efficacy of telaprevir. Viral resistance can develop during treatment with telaprevir, and patients will need to be educated on their role in adherence to minimize the risk of resistance and improve their chances of cure of HCV infection.     

Telaprevir for the treatment of chronic hepatitis C infection

Telaprevir is an NS3/4A protease inhibitor that has recently received US FDA approval for the treatment of chronic HCV infection. Telaprevir is given in combination with peg-IFN-α and ribavirin and is indicated for both treatment-naive and treatment-experienced patients with genotype 1 infection. Along with the other first generation NS3/4A protease inhibitor boceprevir, these combination regimens have immediately become the standard of care for genotype 1 patients. The adverse event profile for the combination regimen remains dominated by peg-IFN-α and ribavirin, but there is additional anemia and rash with telaprevir. Owing to telaprevir's metabolism by the CYP3/4A pathway, drug-drug interactions could lead to toxicity from other medications or decreased efficacy of telaprevir. Viral resistance can develop during treatment with telaprevir, and patients will need to be educated on their role in adherence to minimize the risk of resistance and improve their chances of cure of HCV infection.     

Problems in the treatment of hepatitis C with interferon.

A marked increase in the rate of eradication of hepatitis C virus (HCV) has been achieved by the combination of interferon-alpha2b and ribavirin when compared with interferon-alpha2b alone. However, even with combination therapy, hepatitis persists in more than half of the patients with chronic herpatitis C and progresses to liver cirrhosis and hepatocellular carcinoma with time. What needs to be kept in mind is that, whether by its natural course or by therapy to suppress liver inflammation or by interferon therapy, the rate of development of hepatocellular carcinoma is reduced if ALT is maintained at low levels. Attention should therefore be focused on the development of drugs which enhance the effect of interferon as well as drugs which suppress liver inflammation.     

Future treatment of chronic hepatitis C

The current standard therapy for chronic hepatitis C is peginterferon plus ribavirin and yields a sustained virological response rate of approximately 50% overall. Over the past 2-3 years, many new therapeutic agents directed at a number of different viral targets have entered into development for the treatment of patients with chronic hepatitis C. Many of these agents exhibit high levels of potency against the hepatitis C virus and have a rapid onset of activity. Some agents have been abandoned because of lack of efficacy or toxicity, but many others have shown promise and are undergoing further testing. Although debated, new therapies in the immediate future will most likely be used in combination with peginterferon, either alone or with ribavirin. This concise review is focused on new drugs undergoing development for the treatment of patients with chronic hepatitis C, and on drugs that have shown efficacy in preliminary investigations and progressed to Phase II or III trials. This information should allow physicians involved in the care of patients with chronic hepatitis C to provide realistic expectations of what types of drugs are progressing in clinical development, the likelihood that new treatment will include peginterferon with or without ribavirin, and when these novel therapies might become available.     

Results from a prospective study of individuals' symptoms and patient activation after hepatitis C treatment

The treatment of the hepatitis C virus has been revolutionized by the discovery of direct-acting antiviral medications, which offer more effective treatment with fewer potential side effects. Few studies have examined changes in patient-reported outcomes in individuals undergoing treatment for the hepatitis C virus in the immediate time period after the first treatment (within 1 month). This study is one of the first to use quantitative and qualitative methods to investigate changes in quality of life, patient activation, and symptom burden in adults undergoing treatment for hepatitis C virus with direct-acting antiviral medications. Seventy-three patients were followed in a prospective, longitudinal mixed-methods design. Changes pre and posttreatment in quality of life, patient activation, and symptom burden were very small in magnitude when looking across the entire sample. However, patients with lower self-reported health at baseline reported improved physical and psychological functioning 1-month posttreatment. Patients with higher self-reported health at baseline reported decreased general health posttreatment, although these effects were small. Qualitative results suggested that most patients found symptoms to be manageable despite experiencing both psychological and physical symptoms during treatment. We also found that 25% of patients had low levels of patient activation and may lack the basic knowledge and confidence to be an active participant in their health care. These findings suggest that patients may benefit from tailored information based on current health status about what to expect during and immediately after beginning direct-acting antiviral medication treatment.     

The suitability of mindfulness-based stress reduction for chronic hepatitis C.

As incidence of chronic hepatitis C (CHC) in the United States increases, management of physical and psychological symptoms over the long term becomes crucial. Research has shown meditation to be a valuable tool in reducing such symptoms for various chronic illnesses. In particular, the Mindfulness-Based Stress Reduction (MBSR) program offers curriculum that has been shown to influence both physiology and perception of disease states. Although there has been no direct research to date on the effectiveness of the MBSR program for CHC, several studies have shown significant findings affecting other chronic conditions, including heart disease, fibromyalgia, and HIV. The purpose of this literature review is to examine recent research, summarize findings, and indicate appropriate inclusion of MBSR as a primary, secondary, and tertiary treatment option in conjunction with biomedical care for those diagnosed with CHC. Thusly, nurses can better inform their clients with this condition.     

格林-巴利综合征并重症肝炎患者的观察及护理

目的:探讨格林-巴利综合征(GBS)患者度过危险期,减少病死率的护理对策。方法:对1例格林-巴利综合征患者进行严密的病情观察和精心护理。结果:患者痊愈,肢体功能恢复,生活质量提高。结论:密切观察病情和优良的护理是保证治疗抢救成功的关键。     

Peginterferon alpha/ribavirin combination therapy for the treatment of hepatitis C infection.

Chronic infection with the hepatitis C virus is widespread in the United States. This disease is associated with a progression of fibrosis of the liver leading to liver cirrhosis in as many as 20% of cases. The current standard of care for the treatment of chronic hepatitis C infection is combination therapy with pegylated interferon alpha plus ribavirin. In more than 50% of patients, this regimen has been shown to induce a sustained viral response, defined as undetectable hepatitis C viral ribonucleic acid (RNA) for 6 months after the end of treatment. Typically, patients are treated for 24 or 48 weeks. A number of possible adverse events are associated with combination therapy, and patient empowerment through supportive nursing care is critical to facilitating patient adherence to treatment. This article provides an update on information concerning the diagnosis and treatment of chronic hepatitis C infection. This information can be tailored to provide patient-focused assessment, education, and treatment.     

Recent Canadian experience with targeted hepatitis C virus lookback

BACKGROUND: Targeted hepatitis C virus (HCV) lookback studies have been performed in Canada since 1995. The yield of HCV lookback has not been reassessed since the introduction of improved HCV screening tests. STUDY DESIGN AND METHODS: Data were combined from the two Canadian blood suppliers to determine the yield of targeted HCV lookback performed on donors found to be HCV-positive by antibody screening and/or nucleic acid testing (NAT) from the introduction of NAT in 1999 until January 1, 2005. RESULTS: Lookback was performed on 498 donations from 176 HCV-seropositive and two NAT-only-positive donors; 494 components had been transfused, and 160 components were traced to living recipients who underwent HCV testing. Seventy-two percent of recipients of components derived from donations given before the introduction of second-generation enzyme immunoassay (EIA) testing were HCV-seropositive. Four recipients of components derived from donations tested by second- or third-generation EIA, with or without NAT, were HCV-seropositive. Two of these recipients tested HCV-seropositive before transfusion, and a third was probably infected by transfusions before the introduction of HCV testing. The fourth recipient likely received a noninfectious transfusion, since five other recipients of components from subsequent donations made by this donor were seronegative. CONCLUSION: When previous donations had been tested by second- or third-generation EIA, the yield of HCV lookback was likely zero. Because HCV infection is relatively common in the general population and patients in Canada do not undergo pretransfusion testing, coincident infections in recipients may be erroneously attributed to transfusion. The regulatory requirement for HCV lookback should be reassessed.