Monday, June 27, 2011

Hepatitis C Morning News

Wish List: Nevada Hepatitis C Task Force
Organization: We are a nonprofit 501c3 organization. Our function is to bring awareness and education to the people of Nevada on Hepatitis C. Our goal is to make the people of our state aware of the seriousness of this disease. [...]

Hepatitis C Lifestyle Management: Get Your Sexy Back
Sexual activity harbors enormous benefits to those battling chronic disease. Accordingly, these six tips to help you feel sexy again can also improve how your body manages the Hepatitis C virus. Read more. 

'Hepatitis not transmitted thru mothers' feeding'
Full story: Daily Times
KARACHI: Hepatitis B and C are not inherited to the babies through mother's feeding, said Pakistan Medical Research Council Executive Director Huma Qureshi while talking to Daily Times here last Saturday.

J Viral Hepat. 2011 Jul;18(7):e332-40. doi: 10.1111/j.1365-2893.2010.01426.x. Epub 2011 Feb 1.
Knowledge, attitudes and behaviours associated with the provision of hepatitis C care by Canadian family physicians.
Source
McGill University, Montreal, QC Jewish General Hospital, Montreal, QC Public Health Department, Montreal Health and Social Services Agency, Montreal, QC Département de psychologie, Faculté des sciences humaines, Université du Québec à Montréal, Montreal, QC National Research System (NaReS), The College of Family Physicians of Canada, Montreal, QC Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montreal, QC, Canada.

Abstract
Summary.  The role of primary care physicians in providing care for hepatitis C virus (HCV) infection is increasingly emphasized, but many gaps and challenges remain. This study explores family physicians' knowledge, attitudes and practices associated with providing care for HCV infection. Seven hundred and forty-nine members of the College of Family Physicians of Canada (CFPC) completed a self-administered survey examining knowledge, attitudes and behaviours regarding HCV infection screening and care. Multivariate analyses were performed using the outcome, HCV care provision, and variables based on a conceptual model of practice guideline adherence. Family physicians providing basic-advanced HCV care were more likely to be older, practice in a rural setting, have injection drug users (IDU) in their practice and have higher levels of knowledge about the initial assessment (OR = 1.77; 95% CI = 1.23-2.54) and treatment of HCV (OR = 1.74; 95% CI = 1.24-2.43). They were also less likely to believe that family physicians do not have a role in HCV care (OR = 0.41; 95% CI = 0.30-0.58). Educational programmes should target physicians less likely to provide HCV care, namely family physicians practicing in urban areas and those who do not care for any IDU patients. Training and continuing medical education programmes that aim to shift family physicians' attitudes about the provision of HCV care by promoting their roles as integral to HCV care could contribute to easing the burden on consultant physicians and lead to improved access to treatment for HCV infection.
© 2011 Blackwell Publishing Ltd.

PMID:
21692945
[PubMed - in process]
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How common is it for a patient to develop anemia while being treated for HIV/HCV coinfection? What is the treatment protocol?
Alimentary Pharmacology & Therapeutics, June 2011
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HIV

Premature aging caused by some HIV drugs, study shows
A class of anti-retroviral drugs commonly used to treat HIV, particularly in Africa and low income countries, can cause premature ageing, according to research published today in the journal Nature Genetics. The study shows that the drugs damage DNA in the patient's mitochondria – the 'batteries' which power their cells.The findings may explain why HIV-infected people treated with antiretroviral drugs sometimes show advanced signs of frailty and age-associated diseases such as cardiovascular disease and dementia at an early age.

Nucleoside analogue reverse-transcriptase inhibitors (NRTIs) – of which the most well known is Zidovudine, also known as AZT – were the first class of drug developed to treat HIV. They were a major breakthrough in the treatment of the disease, greatly extending lifespan and leading the condition to be seen as a chronic, rather than terminal, condition.

In high income countries, such as Europe and North America, the older NRTIs are used less commonly now due to concerns over toxicity and side-effects when taken over a long period of time. However, as they are now off-licence and hence relatively cheap, the drugs have proved to be an important lifeline for people infected with HIV in Africa and low income countries.

Professor Patrick Chinnery, a Wellcome Senior Fellow in Clinical Science from the Institute of Genetic Medicine at Newcastle University, says: "HIV clinics were seeing patients who had otherwise been successfully treated but who showed signs of being much older than their years. This was a real mystery. But colleagues recognised many similarities with patients affected by mitochondrial diseases – conditions that affect energy production in our cells – and referred them to our clinic."
Mitochondria are the 'batteries' in our cells which provide them with the energy to carry out their functions. During natural human ageing, these mitochondria acquire mutations, though it is unclear whether these mutations are a cause of ageing or a consequence.

In an attempt to understand what was happening at a cellular level, Professor Chinnery and colleagues studied muscle cells from HIV-infected adults, some of whom had previously been given NRTIs.
The researchers found that patients who had been treated with NRTIs – even as long ago as a decade previously – had damaged mitochondria which resembled that of a healthy aged person.
"The DNA in our mitochondria gets copied throughout our lifetimes and, as we age, naturally accumulates errors," explains Professor Chinnery. "We believe that these HIV drugs accelerate the rate at which these errors build up. So over the space of, say, ten years, a person's mitochondrial DNA may have accumulated the same amount of errors as a person who has naturally aged twenty or thirty years. What is surprising, though, is that patients who came off the medication many years ago may still be vulnerable to these changes."

Co-author and HIV specialist, Dr Brendan Payne, a Medical Research Council fellow from the Department of Infection and Tropical Medicine at the Royal Victoria Infirmary, Newcastle, believes that despite the side effects caused by NRTIs, they are still important drugs and the risks are relative.
"These drugs may not be perfect, but we must remember that when they were introduced they gave people an extra ten or twenty years when they would otherwise have died," he says. "In Africa, where the HIV epidemic has hit hardest and where more expensive medications are not an option, they are an absolute necessity."

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Professor Chinnery and colleagues are now looking at ways to repair or stall some of the damage caused by the medication and believe that focusing on exercise – which appears to have a beneficial effect on patients with mitochondrial diseases – may help.
The study was funded by the Medical Research Council, the British Infection Society, the Newcastle Healthcare Charity, the UK NIHR Biomedical Research Centre for Aging and Age-related Disease and the Wellcome Trust

Hitting moving RNA drug targets
ANN ARBOR, Mich.---By accounting for the floppy, fickle nature of RNA, researchers at the University of Michigan and the University of California, Irvine have developed a new way to search for drugs that target this important molecule. Their work appears in the June 26 issue of Nature Chemical Biology.
Once thought to be a passive carrier of genetic information, RNA now is understood to perform a number of other vital roles in the cell, and its malfunction can lead to disease. The versatile molecule also is essential to retroviruses such as HIV, which have no DNA and instead rely on RNA to both transport and execute genetic instructions for everything the virus needs to invade and hijack its host. As more and more links to disease are discovered, the quest for drugs that target RNA is intensifying.
Searching for such drugs is not a simple matter, however. Most of today's drug-hunting tools are designed to find small molecules that bind to protein targets, but RNA is not a protein, and it differs from proteins in many key features. "So there's a growing need for high-throughput technologies that can identify compounds that bind RNA," said Hashim M. Al-Hashimi, the Robert L. Kuczkowski Professor of Chemistry and Professor of Biophysics at U-M.

Al-Hashimi and coworkers adapted an existing computational technique for virtually screening libraries of small molecules to determine their RNA-binding abilities. In this approach, the shape of a target molecule is first determined by X-ray crystallography or NMR spectroscopy; next, researchers run computer simulations to compute how well various small molecules---potential drugs, for example---nestle into and bind to the target structure. RNA presents a major challenge to this methodology because it doesn't have just one configuration; it's a floppy molecule, and depending on which small molecule it binds, it can assume vastly different shapes.

It once was thought that encounters with drug molecules actually caused RNA's shape changes, and that it was impossible to predict what shape an RNA would adopt upon binding to a given small molecule. However, in earlier research, Al-Hashimi's team challenged this conventional "induced-fit" concept by showing that the RNA, on its own, can dance through the various shapes that it adopts when bound to different drugs. The team discovered that each drug molecule simply "waits" for the RNA to morph into its preferred shape and then latches onto it.
The researchers' previous work involved creating "nano-movies" of RNA that capture this dance of shape changes. In this new study, the researchers froze individual "frames" from the nano-movies, each showing the RNA in a different conformation, and subjected each of them to virtual screening. To test the method in the "real world," they first tried it on compounds already known to bind a particular RNA molecule from HIV called TAR.

"We showed that by virtually screening multiple snapshots of TAR, we could predict at a useful level of accuracy how tightly these different compounds bind to TAR," Al-Hashimi said. "But if we used the conventional method and virtually screened a single TAR structure determined by X-ray crystallography or NMR spectroscopy, we failed to predict binding of these drugs that we know can bind TAR."
Next, the researchers tried using the method to discover new TAR-targeting drugs. They screened about 51,000 compounds from the U-M Life Sciences Institute's Center for Chemical Genomics. "From this relatively small compound library, we ended up identifying six new small molecules that bind TAR and block its interaction with other essential viral molecules," Al-Hashimi said.
What's more, one of the six compounds, netilmicin, showed a strong preference for TAR.
"Netilmicin specifically binds TAR but not other related RNAs," said former graduate student Andrew Stelzer. "We were very pleased with these results because one of the biggest challenges in RNA-targeted drug discovery is to be able to identify compounds that bind a specific RNA target without binding other RNAs. The ability of netilmicin to specifically bind TAR provides proof of concept for this new technology," said Stelzer.

Further experiments showed that, for the six potential drug molecules, the method not only successfully predicted that they would bind to TAR, it also showed---with atomic-level accuracy—where on the RNA molecule each drug would bind.

Al-Hashimi then turned the six drug candidates over to David Markovitz, a professor of infectious diseases at the U-M Medical School, who tested them in cultured human T cells infected with HIV. The point of this experiment was to see if the drugs would prevent HIV from making copies of itself, an essential step in the disease process.

"Netilmicin did in fact inhibit HIV replication," Markovitz said. "This result demonstrates that using an NMR spectrometer and some computers we can discover drugs that target RNA and are active in human cells."
In addition to testing compounds in existing molecular libraries, the virtual screening technique can be used to explore the potential of new compounds that have not yet been synthesized, Al-Hashimi said. "This opens up a whole new frontier for exploring RNA as a drug target and finding new compounds that specifically target it."

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In addition to Al-Hashimi, Stelzer and Markowitz, study authors are U-M graduate students Mike Swanson, Marta Gonzales-Hernandez and Janghyun Lee; U-M undergraduate student Jeremy Kratz; U-C Irvine graduate student Aaron Frank; and U-C Irvine associate professor Ioan Andricioaei.
Funding was provided by the National Institutes of Health, the Michigan Economic Development Corporation and Michigan's Technology Tri-Corridor.
The enabling technology has been exclusively licensed to Nymirum, a drug discovery company that has partnerships with Fortune 500 pharmaceutical and medical companies.
More information:
Hashim Al-Hashimi: https://www.chem.lsa.umich.edu/chem/faculty/facultyDetail.php?Uniqname=Hashimi
Nature Chemical Biology: http://www.nature.com/nchembio/index.html

Addiction

Parents have long warned that drugs will fry your brain. Now doctors say cocaine might also rot your skin — literally

It's no secret that cocaine can be dangerous, but drug dealers might be making it more harmful than ever. The U.S. Drug Enforcement Administration recently reported that 82 percent of the cocaine it seizes has been cut with a veterinary drug that can rot away the skin on users' noses, cheeks, and ears. "It's probably quite a big problem," says dermatologist Dr. Noah Craft with the Los Angeles Biomedical Research Insitute. "We just don't know how big." Here, a brief guide:

How does levamisole end up in cocaine?
Drug dealers typically add fillers to cocaine to boost their profits. Cheaper cocaine may be upwards of 90 percent filler. Sometimes, the added powder is just baking soda or some other innocuous substance. But drug cartels in South America increasingly prefer to use levamisole, a veterinary antibiotic normally used to deworm cattle, sheep, and pigs. It's not clear why dealers don't just use baking soda all the time, although though studies in rats suggest that levamisole might tingle brain receptors in the same way cocaine does. If that's the case, adding it to the supply might be a way to enhance the effects of cocaine on the cheap.

And the user ends up paying the price?
Yes, in some cases, says Craft, who has published a case study in Journal of the American Academy of Dermatology. Craft linked six patients with patches of dying flesh to tainted cocaine. The wounds typically surface a day after exposure due to an immune reaction that damages blood vessels supplying the skin. Without any blood supply, the skin is starved of oxygen, turns a dark purple, and dies off. While the contamination of the cocaine supply is widespread, not all of those using cocaine experience this adverse reaction. But, anyone who uses cocaine is at risk, Craft says. "Rich or poor, black or white."

Are doctors just discovering this problem?
No, levamisole has been on the radar screen of drug-prevention officials and doctors for a while. In 2009, there were reports of a handful of cocaine users in Canada developing hepatitis C and anemia after using cocaine mixed with levamisole. The killer agent hinders a person's ability to produce white blood cells, which are essential for fighting off sometimes deadly infections. But the DEA's report on the extent of the contamination, explains why some doctors are now seeing gruesome wounds linked to recent cocaine use. "It's important for people to know it's not just in New York and L.A.," says Craft. "It's in the cocaine supply of the entire U.S."
Sources: ABC News, Avvo, Sun Sentinel
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Infectious Disease

Mutated scarlet fever fuels Hong Kong outbreak
Ultramodern Hong Kong is tussling with a centuries-old bug long forgotten in many developed countries - an outbreak of drug-resistant scarlet fever that has killed the first children there in a decade. And with it is the rise of a mutated strain that appears to be more contagious....

Healthy You

Heart risks lower in men who get enough vitamin D-study

NEW YORK, June 27 - | Sun Jun 26, 2011 9:45pm EDT
NEW YORK, June 27 - (Reuters Life!) - Men who consume the recommended amount of vitamin D are somewhat less likely to suffer a heart attack or stroke than those with low vitamin D, according to a U.S. study. The study, which followed nearly 119,000 adults for two decades and was published in the American Journal of Clinical Nutrition, found that men who got at least 600 IU of vitamin D per day, the current recommended amount, were 16 percent less likely to develop heart problems or stroke than men who got less than 100 IUD per day.
But there was no such pattern among women, wrote lead research Qi Sun at the Harvard School of Public Health.

"These observations suggest that a higher intake of vitamin D is associated with a lower risk of cardiovascular disease in men but not in women," Sun wrote.
But Sun and the other authors said the findings don't yet prove that vitamin D, which is found in fish, eggs, fortified milk and cod liver oil, deserves the credit for the lower risk found in men.
"The evidence is not strong enough yet to make solid recommendations," Sun added.
The current study was observational, based on data from two long-term projects that have followed two large groups of U.S. health professionals since the 1980s: the Nurses' Health Study and the Health Professionals Follow-up Study.

Out of 45,000 men, there were about 5,000 new cases of cardiovascular disease over the study period, marked by a heart attack, stroke or cardiovascular death.
It's not clear why the finding in men wasn't matched by a similar pattern in women, but Sun said one possibility is that women may have less active vitamin D circulating in the blood.
Vitamin D is also stored in fat, and women typically have a higher percentage of body fat than men do.
But more research is needed, Sun said, adding that more answers are expected from an ongoing randomized trial evaluating whether a high dose of vitamin D (2,000 IU per day) can cut the risk of heart disease, stroke and other chronic diseases. SOURCE: bit.ly/irO9Xe (Reporting by Amy Norton at Reuters Health; editing by Elaine Lies
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Soluble Fiber Strikes a Blow to Belly Fat
WINSTON-SALEM, N.C. – All fat is not created equal. Unsightly as it is, subcutaneous fat, the fat right under the skin, is not as dangerous to overall health as visceral fat, the fat deep in the belly surrounding vital organs.

According to a new study by researchers at Wake Forest Baptist Medical Center, the way to zero in and reduce visceral fat is simple: eat more soluble fiber from vegetables, fruit and beans, and engage in moderate activity.

The study found that for every 10-gram increase in soluble fiber eaten per day, visceral fat was reduced by 3.7 percent over five years. In addition, increased moderate activity resulted in a 7.4 percent decrease in the rate of visceral fat accumulation over the same time period.

“We know that a higher rate of visceral fat is associated with high blood pressure, diabetes and fatty liver disease,” said Kristen Hairston, M.D., assistant professor of internal medicine at Wake Forest Baptist and lead researcher on the study. “Our study found that making a few simple changes can have a big health impact.”

Ten grams of soluble fiber can be achieved by eating two small apples, one cup of green peas and one-half cup of pinto beans; moderate activity means exercising vigorously for 30 minutes, two to four times a week, Hairston added.

In the longitudinal study, published in the June 16 online issue of the journal Obesity, researchers examined whether lifestyle factors, such as diet and frequency of exercise, were associated with a five-year change in abdominal fat of African Americans and Hispanic Americans, populations at a disproportionally higher risk for developing high blood pressure and diabetes and accumulating visceral fat.

At the beginning of the study, which involved 1,114 people, the participants were given a physical exam, an extensive questionnaire on lifestyle issues, and a CT scan, the only accurate way to measure how much subcutaneous and visceral fat the participants had. Five years later, the exact same process was repeated.

Researchers found that increased soluble fiber intake was associated with a decreased rate of accumulated visceral fat, but not subcutaneous fat.

“There is mounting evidence that eating more soluble fiber and increasing exercise reduces visceral or belly fat, although we still don’t know how it works,” Hairston said. “Although the fiber-obesity relationship has been extensively studied, the relationship between fiber and specific fat deposits has not. Our study is valuable because it provides specific information on how dietary fiber, especially soluble fiber, may affect weight accumulation through abdominal fat deposits.”

Hairston’s next study, expected to be in clinical trials later this summer, will examine whether increasing soluble fiber with a widely available fiber supplement will produce similar results to those obtained in this study using soluble fiber from food.

Funding for the study was provided by the National Institutes of Health.

Media Relations Contacts:
Marguerite Beck: marbeck@wakehealth.edu,
336-716-2415
Bonnie Davis: bdavis@wakehealth.edu,
336-716-4977

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