Baby Boomers at Risk of Hidden Hepatitis C

Due to a number of risk factors, including intravenous drug use and limited testing of the blood supply before 1992, those born from 1946 to 1964 -- baby boomers -- are at the highest risk for having the hepatitis C virus, as reported by CBSNews.com.

Health officials such as those at Montefiore Medical Center were already expressing concern about the health risks associated with the illness that is labeled a "silent epidemic" for baby boomers, even before recent study revealed the mortality rate for hepatitis C in that age group.

Hepatitis C Study Results

The Centers for Disease Control and Prevention funded a study, reported Tuesday in the Annals of Internal Medicine, titled "The Increasing Burden of Mortality From Viral Hepatitis" in the U.S. from 1999 through 2007.

The study researchers concluded that deaths from HCV outnumbered those from HIV by 2007. Even more pertinent for baby boomers are the deaths from HCV were disproportionately high in their age group.

Those numbers might have been higher, but because the physician signing the death certificates were often not the person's primary caregiver, HCV might have been under-reported as a contributing cause of death.

Plans to Address Undiagnosed Hepatitis C

A second study published Tuesday, also in the Annals of Internal Medicine, addresses the cost-effectiveness of a one-time antibody blood test to determine if people born from 1945 to 1965 have the hepatitis C virus present in their bodies. This study, also funded by the CDC and the Division of Viral Hepatitis, concluded it would be cost-effective to perform such blood screening through a person's visit to their primary health care giver.

Importance of Diagnosing Hepatitis C

Milan Kinkhabwala of the Montefiore Einstein Center for Transplantation explains, "The blood test is essential to detecting Hepatitis C because now there are ways to treat the condition, and even reverse damage to the liver."

But people can't receive treatment until they know they have an illness, and HCV can be present in the body for a long period of time before symptoms occur, as the CDC's director of hepatitis division, John Ward, said to Bloomberg. The blood test would reveal the hidden virus and allow health care providers to treat HCV before more liver damage, such a liver cancer, can occur.

Risk Factors for Hepatitis C

There are a number of factors that, if present, indicate your risk of having hepatitis C is greater than people who have no risk factors. The Mayo Clinic lists some of these factors as having HIV; having used illegal, injectable drugs; a health care worker exposed to infected blood; received a blood transfusion or organ transplant prior to 1992; or received clotting factor concentrates before 1987.

Smack dab in the middle of the baby boomer generation, L.L. Woodard is a proud resident of "The Red Man" state. With what he hopes is an everyman's view of life's concerns both in his state and throughout the nation, Woodard presents facts and opinions based on common-sense solutions.

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Hepatitis C deaths up, baby boomers most at risk

WASHINGTON (AP) — Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers especially should take heed — they are most at risk.

Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if their livers harbor this ticking time bomb. The reason: Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days.

The issue has taken new urgency since two drugs hit the market last summer that promise to cure many more people than ever was possible. And research published Monday says testing millions of the middle-aged to find those who need the pricey treatment would be worth the cost, saving thousands of lives.

"One of every 33 baby boomers are living with hepatitis C infection," says Dr. John Ward, hepatitis chief at the Centers for Disease Control and Prevention. "Most people will be surprised, because it's a silent epidemic."

Don't think you need to worry? Yes, sharing a needle while injecting illegal drugs is the biggest risk factor for becoming infected with this blood-borne virus. But before 1992, when widespread testing of the blood supply began, hepatitis C commonly was spread through blood transfusions. Plus, a one-time experiment with drugs way back in high school or college could have been enough.

"Asking someone about a risk that happened 20 to 30 years ago is a lot to ask," says Ward. Hence the quest for a new strategy.

About 3.2 million Americans are estimated to have chronic hepatitis C, but at least half of them may not know it. The virus, which affects 170 million people worldwide, can gradually scar the liver and lead to cirrhosis or liver cancer. It is a leading cause of liver transplants.

A CDC study published Monday analyzed a decade of death records and found an increase in death rates from hepatitis C. In fact, in 2007 there were 15,000 deaths related to hepatitis C, higher than previous estimates — and surpassing the nearly 13,000 deaths caused by the better-known AIDS virus.

Perhaps more surprising, three-fourths of the hepatitis deaths occurred in the middle-aged, people 45 to 64, researchers reported in Annals of Internal Medicine.

"Mortality will continue to grow for the next 10 to 15 years at least unless we do something different" to find and treat the silent sufferers, Ward says.

CDC's current guidelines recommend testing people known to be at high risk, and until last summer there wasn't much enthusiasm even for that step: the reasons are the year-long, two-drug treatment promised to cure only 40 percent of people; treatment was so grueling that many patients refused to try it and treatment could cost up to $30,000.

Two new drugs — Vertex Pharmaceuticals' telaprevir and Merck & Co.'s boceprevir — are starting to change that pessimism. Research suggests adding one of them to standard therapy can boost cure rates as high as 75 percent. While still full of side effects, they can allow some people to finish treatment in just six months. They add to the price, however, another $1,000 to $4,000 a week. Drugs that promise to work even better have begun testing.

Those advances are fueling CDC deliberations of whether to change testing guidelines to recommend that anyone born between 1945 and 1965 get a one-time screening. A second CDC-funded study published Monday analyzed models of that option, and concluded it had the potential to save 82,000 lives.

A third study published Monday from Stanford University looked more closely at the price tag, and concluded the new triple-therapy would be cost-effective for people with advanced disease. It's still cheaper than a transplant costing well over $100,000. But not everyone with hepatitis C will go on to suffer serious liver damage. For those with mild disease, that analysis concluded some gene testing to predict who might really need the costlier triple therapy rather than the older drugs would be a good next step.

It's not clear how quickly the CDC will settle the boomer-screening question. But doctors at New York's Montefiore Medical Center have started raising the issue with boomers. And Montefiore internist Dr. Gary Rogg says a number of patients have sought testing after seeing hepatitis-awareness ads from the drugs' manufacturers.

"Now it's considered a curable disease, that makes all the difference," says Rogg, who was surprised at some longtime patients' test results. Even a nurse he knows learned she had it, and the only risk she could recall was a blood transfusion during surgery when she was 10 years old.

___

EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

___

Online: Centers for Disease Control and Prevention: http://www.cdc.gov/

Montefiore Medical Center: http://bit.ly/u6scH0

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Hepatitis C Now Kills More Americans Than HIV

MONDAY, Feb. 20 (HealthDay News) -- Deaths from hepatitis C have increased steadily in the United States in recent years, in part because many people don't know they have disease, a new government report says.

More Americans now die of hepatitis C than from HIV, the AIDS-causing virus, according to 1999-2007 data reviewed by the U.S. Centers for Disease Control and Prevention (CDC). And most of those dying are middle-aged.

"These data underscore the urgent need to address the health threat posed by chronic hepatitis B and C in the United States," said investigator Dr. Scott Holmberg, chief of the Epidemiology and Surveillance Branch in CDC's Division of Viral Hepatitis.

About 3.2 million Americans are infected with hepatitis C, a major cause of liver cancer and cirrhosis, the CDC authors said. An estimated one-half to three-quarters of infected adults are unaware they have the disease, which progresses slowly.

Hepatitis C is spread through injection drug use, from blood transfusions received before routine blood-screening began in 1992, and through sexual contact. In some cases, it passes from mothers to infants.

"Chronic hepatitis is a leading and preventable cause of premature death in the United States," Holmberg said. "Over time, leaving viral hepatitis untreated can lead to costly care and treatments, and lifetime costs can total hundreds of thousands of dollars. However, early detection and intervention can be cost-effective and save lives."

The new study highlights the need to increase hepatitis awareness and the critical importance of testing, Holmberg said. Screening will increase diagnoses and treatment, thereby reducing hepatitis-related deaths, he said.

The report is published in the Feb. 21 issue of the Annals of Internal Medicine.

Using death records from 1999 to 2007, researchers collected data on some 22 million Americans, looking for those who died from hepatitis B, C and HIV.

The investigators found deaths from hepatitis C surpassed deaths from HIV (15,000 from hepatitis C versus 13,000 from HIV). They also found that deaths from hepatitis C and B are mostly among the middle-aged.

"Seventy-three percent of hepatitis C deaths were reported among those 45 to 64 years old," Holmberg said. "As the population living with hepatitis C in the United States -- 66 percent of whom were born between 1945 and 1964 -- has aged and entered a high-risk period of life for hepatitis C-related disease, deaths associated with hepatitis C have increased substantially."

Vaccines exist for hepatitis B, but not for hepatitis C. If current trends continue, by 2030 deaths from hepatitis C are expected to reach 35,000 a year, researchers say.

According to Dr. Eugene Schiff, director of the Center for Liver Diseases at the University of Miami Miller School of Medicine, "the study is important because it documents and authenticates what we knew." But, "what we need right now, particularly for hepatitis C, is routine screening," noted Schiff, who was not involved with the study.

Dramatic changes are under way in the treatment of hepatitis C, he pointed out. Current treatment involves a cocktail of drugs, including antivirals and interferon, which many people cannot tolerate.

In about two years, interferon-free treatment will be available, Schiff said. This means higher cure rates with fewer side effects, which will make treatment tolerable by most patients, he explained.

"What's going to happen is what happened with HIV -- test and treat," Schiff said. "Patients will be given an interferon-free regimen with cure rates approaching 100 percent," he predicted.

Another study in the same journal issue found that the most up-to-date treatment for hepatitis C can cost $60,000, but may be cost-effective, according to Stanford University health policy researchers.

In a study led by Jeremy Goldhaber-Fiebert, an assistant professor of medicine at the School of Medicine, investigators developed a computer model to assess the cost-effectiveness of a new treatment for hepatitis C. Their model showed that for people with advanced disease the cost was justified in terms of results.

The treatment involves use of two drugs called protease inhibitors -- boceprevir (brand name Victrelis) and telaprevir (brand name Incivek) -- in addition to interferon and an antiviral.

While the new treatment is expensive and may cause side effects, it could reduce patients' risks for cancer and liver transplants, thereby avoiding those costly events and possibly helping patients live longer, better lives, the researchers pointed out in a journal news release.

Yet another study in the journal recommends one-time screening of all those born between 1945 and 1965, instead of waiting until symptoms appear.

More information

For more information on hepatitis, visit the U.S. Centers for Disease Control and Prevention.

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Hepatitis C Now Killing More Americans than HIV

hepatitis_c_hiv_deaths Image courtesy of iStockphoto/sjlocke

The number of people who die from HIV-related causes each year in the U.S. is now down to about 12,700 from a peak of more than 50,000 in the mid-1990s thanks to condom education and distribution campaigns, increased testing and improved treatments. But now a different infectious disease is quietly killing even more people than HIV is: Hepatitis C.

The majority of the 3.2 million people who are estimated to have chronic hepatitis C virus (HCV) in the U.S. are baby boomer adults.

And most of those infected with the virus do not know that they have it, which means they could easily be spreading it to others via exposure to blood or, occasionally, sexual contact.

Although long-term intravenous drug users are at particular risk, so are “those who experimented with [such] drugs for a limited time in their youth,” Harvey Alter and T. Jake Liang, both of the National Institutes of Health, wrote in an essay published online Monday in Annals of Internal Medicine. “These bygone experiences do not often connote risk to the affected persons nor serve as a reason to seek testing,” they noted, making this slow-developing disease difficult to catch before it develops into cirrhosis or liver cancer (hepatocellular carcinoma). Their essay was part of a four-paper special series on hepatitis C.

More than 15,000 people died from hepatitis C-related issues in the U.S. in 2007 about three quarters of whom were people aged 45 to 64, according to Alter and Liang. And that number is expected to double as the bulk of the population with the disease get older. The cost of treating all of these people is likely to top $6.7 billion in the decade of 2010 to 2019.

Much of that growth is anticipated because those infected with hepatitis C often don’t seek treatment until the disease has caused serious damage, according to another paper published Monday in the same issue of Annals of Internal Medicine. “Hepatitis C virus infection is often asymptomatic or causes nonspecific symptoms (depression, arthralgia and fatigue) for decades,” Kathleen Ly, of the U.S. Centers for Disease Control and Prevention (CDC), and her colleagues wrote in their paper.

The good news for those who do get diagnosed is that new hepatitis C drugs are coming onto the market. But they are not cheap. One new promising one, a protease inhibitor called boceprevir, runs about $1,100 per week, which when added to the double-drug cocktail of interfearon and the antiviral ribavirin, makes for especially expensive treatment. Some researchers have proposed that testing patients for a genotype that has a cure rate of less than 40 percent with previous treatment might help make treatment the more cost effective.

A new analysis in the same issue of Annals of Internal Medicine, led by Shan Liu of the Center for Health Policy at Stanford University, found that giving HCV patients of all genotypes a triple-drug cocktail is, indeed, cost-effective for allowing patients to live longer, healthier lives. And as Alter and Liang pointed out, as opposed to HIV or even hepatitis B, HCV can often be effectively cured after six months to a year of antiviral treatment. “Every effectively treated high-risk individual diminishes the infectious pool and the likelihood of secondary transmission.”

With treatment options expanding, many researchers are turning their attention back to the question of locating patients. “As innovative treatments for hepatitis C follow their now-destined progression, the most burning question will not be whether to treat, but rather how to identify the many chronic HCV carriers who are unaware of their infection and are at risk for cirrhosis, end-stage liver disease, or hepatocellular carcinoma,” Alter and Liang wrote.

Knowing that those born between 1945 and 1964 are at the highest risk for HCV infection could help guide screening, according to another study published in the same issue of the journal, led by David Rein, of the CDC. “Because HCV progresses slowly, the risk for serious complications is increasing among infected Americans as time passes,” he and his colleagues wrote. “Without changes in current case identification and treatment, deaths from HCV are forecasted to increase to 35,000 annually by 2030.”

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.

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Jon Secada joins campaign on chronic hepatitis C

MIAMI (Reuters) - Grammy-award winning Cuban-American singer Jon Secada added his voice on Thursday to a growing public health campaign to raise awareness of chronic hepatitis C infection.

Secada, 50, revealed that his father died last November from complications associated with hepatitis C, after failing to seek proper medical treatment for many years and keeping the disease a secret, even from family members.

Secada is joining forces with the American Liver Foundation in a campaign 'Tune in to Hep C,' backed by fellow singers Gregg Allman of The Allman Brothers and Natalie Cole, 62, the daughter of jazz legend Nat King Cole.

Cole had a life-saving liver transplant in 2009 after she was stricken with the disease, the legacy of drug abuse in her earlier life.

Secada hopes speaking out about his family's experience can help break a taboo attached to the disease and encourage greater understanding about its risks, he told Reuters in an interview.

"My father chose not to tell anyone about his disease for a long time, and he chose not to take action against it for reasons I may never understand," he said. "By the time he was able to explore any aggressive medications it was too late."

Secada does not know how his father contracted the virus, which began to affect his health about eight years ago. His father, Jose Secada, was a political prisoner in Cuba for three years in the 1960s and left the island with his family in 1970.

"Before he passed away, he told me that he wanted me to share his story to help other people like him who have chronic hepatitis C but aren't taking action," Secada said.

"Take it from me, you need to talk to your doctor and talk to your family."

An estimated 3 million to 4 million Americans and 180 million people worldwide are infected with hepatitis C, which causes progressive damage to the liver over many years. If untreated it can lead to cirrhosis, liver cancer and death. It is also the leading cause of liver transplants.

The virus that causes it is spread through the blood, typically through shared needles or from blood transfusions prior to the early 1990s, when routine screening for the virus became standard practice.

"That's why we are seeing an outbreak of it now. The baby boomers were more exposed to it," said Dr. Leopoldo Arosemena, an assistant professor of medicine at the University of Miami who specializes in liver dieses.

Others picked up the virus from sharing razors or needles used for tattoos or intravenous drug use. The latter created the stigma associated with the disease.

SOCIAL STIGMA

"Many people think that just because you have the virus you were doing something you shouldn't be doing," said Arosemena. People automatically think drugs, but in reality they often got it from sources they trusted, contaminated equipment, tattoos, or other things."

Many don't know they are carrying the disease as it can lay dormant for decades. A simple blood test can detect the presence of the disease, which can be successfully treated with a range of new drugs.

"I advise everyone in doubt to get tested," said Arosemena. "By the time it gets to you it might be too late."

The disease disproportionately affects Hispanics who account for almost one third of cases in the United States, due in part to poor hygiene in clinics and hospital in Latin America, as well as tattoos and drug abuse.

"In Latin America it's common for people to get injected at home by a neighbor with old glass syringes that you boil and use again," said Arosemena, noting that the hepatitis C virus is resistant to high temperatures.

Last year marked a major advance in the treatment of hepatitis C with the approvals in May of two new medicines - Incivek from Vertex Pharmaceuticals and Victrelis from Merck & Co - that offer the promise of far higher cure rates and the potential for shortened treatment durations than the previous standard drugs.

Both companies have sponsored hepatitis C awareness campaigns, and Merck is working with Secada's campaign.

News of the new medicines caught the attention of many people with hepatitis C who had been putting off treatment and Vertex has booked sales in excess of $950 million just since May.

Prior to the availability of the new medicines, patients had to take medications that caused flu-like symptoms that left patients feeling miserable for nearly the entire duration of the 48-week treatment.

As a result many patients with the disease - many of whom are asymptomatic - would discontinue or put off treatment altogether rather than deal with the onerous side effects.

Meanwhile, excitement is building for the next wave of treatments several companies are working on that are still a couple of years off but appear to be highly effective so far in clinical trials.

He continues to perform regularly and recently returned from appearances in Peru, Mexico and Argentina. He brought out a Spanish language album last year, Otra Vez, and has a new album due out later this year featuring Cyndi Lauper, as well as , says he has been tested and does not have the virus.

Born in Cuba, he left the island when he was 8 and had a string of cross-over hits in English and Spanish in the early 1990s before his career dimmed.recording the anthem for a global world peace "super-concert."

Secada still performs regularly and just returned from giving concerts in Peru, Mexico and Argentina.

(Reporting By David Adams; Additional reporting by Bill Berkrot; editing by Todd Eastham)

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Jon Secada joins campaign on chronic hepatitis C

MIAMI (Reuters) - Grammy-award winning Cuban-American singer Jon Secada added his voice on Thursday to a growing public health campaign to raise awareness of chronic hepatitis C infection.

Secada, 50, revealed that his father died last November from complications associated with hepatitis C, after failing to seek proper medical treatment for many years and keeping the disease a secret, even from family members.

Secada is joining forces with the American Liver Foundation in a campaign 'Tune in to Hep C,' backed by fellow singers Gregg Allman of The Allman Brothers and Natalie Cole, 62, the daughter of jazz legend Nat King Cole.

Cole had a life-saving liver transplant in 2009 after she was stricken with the disease, the legacy of drug abuse in her earlier life.

Secada hopes speaking out about his family's experience can help break a taboo attached to the disease and encourage greater understanding about its risks, he told Reuters in an interview.

"My father chose not to tell anyone about his disease for a long time, and he chose not to take action against it for reasons I may never understand," he said. "By the time he was able to explore any aggressive medications it was too late."

Secada does not know how his father contracted the virus, which began to affect his health about eight years ago. His father, Jose Secada, was a political prisoner in Cuba for three years in the 1960s and left the island with his family in 1970.

"Before he passed away, he told me that he wanted me to share his story to help other people like him who have chronic hepatitis C but aren't taking action," Secada said.

"Take it from me, you need to talk to your doctor and talk to your family."

An estimated 3 million to 4 million Americans and 180 million people worldwide are infected with hepatitis C, which causes progressive damage to the liver over many years. If untreated it can lead to cirrhosis, liver cancer and death. It is also the leading cause of liver transplants.

The virus that causes it is spread through the blood, typically through shared needles or from blood transfusions prior to the early 1990s, when routine screening for the virus became standard practice.

"That's why we are seeing an outbreak of it now. The baby boomers were more exposed to it," said Dr. Leopoldo Arosemena, an assistant professor of medicine at the University of Miami who specializes in liver dieses.

Others picked up the virus from sharing razors or needles used for tattoos or intravenous drug use. The latter created the stigma associated with the disease.

SOCIAL STIGMA

"Many people think that just because you have the virus you were doing something you shouldn't be doing," said Arosemena. People automatically think drugs, but in reality they often got it from sources they trusted, contaminated equipment, tattoos, or other things."

Many don't know they are carrying the disease as it can lay dormant for decades. A simple blood test can detect the presence of the disease, which can be successfully treated with a range of new drugs.

"I advise everyone in doubt to get tested," said Arosemena. "By the time it gets to you it might be too late."

The disease disproportionately affects Hispanics who account for almost one third of cases in the United States, due in part to poor hygiene in clinics and hospital in Latin America, as well as tattoos and drug abuse.

"In Latin America it's common for people to get injected at home by a neighbor with old glass syringes that you boil and use again," said Arosemena, noting that the hepatitis C virus is resistant to high temperatures.

Last year marked a major advance in the treatment of hepatitis C with the approvals in May of two new medicines - Incivek from Vertex Pharmaceuticals and Victrelis from Merck & Co - that offer the promise of far higher cure rates and the potential for shortened treatment durations than the previous standard drugs.

Both companies have sponsored hepatitis C awareness campaigns, and Merck is working with Secada's campaign.

News of the new medicines caught the attention of many people with hepatitis C who had been putting off treatment and Vertex has booked sales in excess of $950 million just since May.

Prior to the availability of the new medicines, patients had to take medications that caused flu-like symptoms that left patients feeling miserable for nearly the entire duration of the 48-week treatment.

As a result many patients with the disease - many of whom are asymptomatic - would discontinue or put off treatment altogether rather than deal with the onerous side effects.

Meanwhile, excitement is building for the next wave of treatments several companies are working on that are still a couple of years off but appear to be highly effective so far in clinical trials.

He continues to perform regularly and recently returned from appearances in Peru, Mexico and Argentina. He brought out a Spanish language album last year, Otra Vez, and has a new album due out later this year featuring Cyndi Lauper, as well as , says he has been tested and does not have the virus.

Born in Cuba, he left the island when he was 8 and had a string of cross-over hits in English and Spanish in the early 1990s before his career dimmed.recording the anthem for a global world peace "super-concert."

Secada still performs regularly and just returned from giving concerts in Peru, Mexico and Argentina.

(Reporting By David Adams; Additional reporting by Bill Berkrot; editing by Todd Eastham)

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Merck says hepatitis pill hampers HIV Drugs

(Reuters) - Merck & Co's recently approved Victrelis treatment for hepatitis C considerably lessens the effectiveness of some widely used medicines against the virus that causes AIDS, Merck and U.S. regulators said in separate reports.

"These drug interactions may be clinically significant for patients infected with both chronic hepatitis C virus and HIV by potentially reducing the effectiveness of these medicines when co-administered," Merck said in a February 6 letter to healthcare professionals.

Victrelis, approved last May, attacks the hepatitis C virus that over decades can lead to cirrhosis and liver failure. A significant percentage of hepatitis patients are also infected with the human immunodeficiency virus, or HIV, which weakens the immune system and is fatal without treatment.

The drug interactions were seen in a study among healthy volunteers who took Victrelis and the widely used HIV treatment Norvir in combination with one of three other anti-HIV pills: Reyataz (atazanavir), Prezista (darunavir) and Kaletra (lopinavir/ritonavir). All of the HIV drugs work by blocking protease, an enzyme the virus requires to replicate.

Victrelis reduced concentrations in the blood of Reyataz, Prezista and Kaletra by an average 49 percent, 59 percent and 43 percent, respectively.

Further, levels of Victrelis itself were reduced by 45 percent among volunteers who took it with Kaletra, and 32 percent among those who took it with a combination of Norvir and Prezista.

ISI Group analyst Mark Schoenebaum said 10 percent to 15 percent of patients with hepatitis C are co-infected with HIV, and the findings could crimp Victrelis sales by as much as 25 percent. But he said the setback would have little impact on Merck's earnings this year or in 2013.

The reduced prospects for Victrelis come even as its sales are being dwarfed by Vertex Pharmaceuticals Inc's Incivek, a rival protease inhibitor that was also approved last May.

The U.S. Food and Drug Administration, in an announcement of the findings that appeared on the agency's website on Wednesday, said patients should not stop taking any of their medicines without talking to healthcare professionals.

Drug interactions had previously been found between Victrelis and another HIV treatment called Sustiva (efavirenz). Sustiva belongs to a family of HIV drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Merck said it was conducting drug-interaction studies of Victrelis with other HIV drugs. They include Intelence (etravirine), which is also a NNRTI, and Isentress (raltegravir), which belongs to a class of drugs called HIV integrase inhibitors,

Merck shares slid 14 cents to $38.28 in afternoon trading on the New York Stock Exchange.

(Reporting By Ransdell Pierson; editing by John Wallace and Maureen Bavdek)

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Merck says hepatitis pill hampers HIV Drugs

(Reuters) - Merck & Co's recently approved Victrelis treatment for hepatitis C considerably lessens the effectiveness of some widely used medicines against the virus that causes AIDS, Merck and U.S. regulators said in separate reports.

"These drug interactions may be clinically significant for patients infected with both chronic hepatitis C virus and HIV by potentially reducing the effectiveness of these medicines when co-administered," Merck said in a February 6 letter to healthcare professionals.

Victrelis, approved last May, attacks the hepatitis C virus that over decades can lead to cirrhosis and liver failure. A significant percentage of hepatitis patients are also infected with the human immunodeficiency virus, or HIV, which weakens the immune system and is fatal without treatment.

The drug interactions were seen in a study among healthy volunteers who took Victrelis and the widely used HIV treatment Norvir in combination with one of three other anti-HIV pills: Reyataz (atazanavir), Prezista (darunavir) and Kaletra (lopinavir/ritonavir). All of the HIV drugs work by blocking protease, an enzyme the virus requires to replicate.

Victrelis reduced concentrations in the blood of Reyataz, Prezista and Kaletra by an average 49 percent, 59 percent and 43 percent, respectively.

Further, levels of Victrelis itself were reduced by 45 percent among volunteers who took it with Kaletra, and 32 percent among those who took it with a combination of Norvir and Prezista.

ISI Group analyst Mark Schoenebaum said 10 percent to 15 percent of patients with hepatitis C are co-infected with HIV, and the findings could crimp Victrelis sales by as much as 25 percent. But he said the setback would have little impact on Merck's earnings this year or in 2013.

The reduced prospects for Victrelis come even as its sales are being dwarfed by Vertex Pharmaceuticals Inc's Incivek, a rival protease inhibitor that was also approved last May.

The U.S. Food and Drug Administration, in an announcement of the findings that appeared on the agency's website on Wednesday, said patients should not stop taking any of their medicines without talking to healthcare professionals.

Drug interactions had previously been found between Victrelis and another HIV treatment called Sustiva (efavirenz). Sustiva belongs to a family of HIV drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Merck said it was conducting drug-interaction studies of Victrelis with other HIV drugs. They include Intelence (etravirine), which is also a NNRTI, and Isentress (raltegravir), which belongs to a class of drugs called HIV integrase inhibitors,

Merck shares slid 14 cents to $38.28 in afternoon trading on the New York Stock Exchange.

(Reporting By Ransdell Pierson; editing by John Wallace and Maureen Bavdek)

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Amateur tattoos carry hepatitis C risk: CDC

NEW YORK (Reuters Health) - If you're planning on getting a tattoo, make sure it's from a professional and not your friend, says a new report from the Centers for Disease Control and Prevention (CDC).

In an analysis of several dozen past studies, CDC researchers found that tattoos from non-professionals appear to carry a risk of the blood-borne liver infection hepatitis C. That included tattoos done by friends or family, or ones done in prison.

On the other hand, there was no evidence that tattoos done by professionals carried a hepatitis C risk.

Hepatitis C is passed through contact with infected blood. In the U.S., there are roughly 18,000 new infections each year, most of which occur when people who inject heroin and similar drugs share tainted needles or syringes.

But in almost 20 percent of acute hepatitis C infections, the person has no known risk factor, said Dr. Rania A. Tohme, a medical epidemiologist at the CDC who led the new study.

Given that -- and the popularity of tattoos -- there have been concerns that the body art could be a risk factor for hepatitis C.

Based on these findings, it's the tattoos from non-pros that consumers should beware, according to Tohme.

"Tattoos and piercings can transmit hepatitis C and other infections if performed under non-sterile conditions," Tohme told Reuters Health in an email. "People should not have tattoos or piercings done by friends or by people who are not trained professionals."

The findings, published in the journal Clinical Infectious Diseases, are based on a collection of studies published since 1994.

In general, people who had tattoos done by non-professionals faced a hepatitis C risk that was two to four times higher than average.

Prison tattoos are a particular concern, Tohme's team writes, because tattooing is so common, and many prisoners may have other risk factors for hepatitis C. And outbreaks of the infection have been linked to tattooing among prisoners.

But no U.S. outbreaks have been tied to professional tattoo parlors.

"To this date, there has been no evidence that tattoos and piercings performed in professional parlors in the United States have been implicated in transmission of hepatitis C virus," Tohme said.

Still, you can take some precautions if you're thinking of inking up.

Tohme said to make sure the tattoo artist is using sterile equipment, including single-use needles and ink that has not been used on anyone else.

"Disposable piercing needles, tattoo needles and razors are used on one person and then thrown away. Reusing needles or razors is not safe," Tohme said.

In the U.S., new cases of hepatitis C infection have fallen sharply since the 1980s, according to the CDC.

But chronic hepatitis C infection remains a major public health problem, the agency says.

Between 75 percent and 85 percent of people infected with hepatitis C develop chronic infection, which can eventually cause serious liver diseases like cirrhosis (scarring of the liver) and liver cancer.

An estimated 3.2 million Americans have chronic hepatitis C, about half of whom are unaware of it. (The initial infection most often causes no symptoms.)

There are medications for treating chronic hepatitis C, though they are not effective for everyone and have side effects like fatigue, nausea, headache and sleep problems.

SOURCE: http://bit.ly/w6rw3u Clinical Infectious Diseases, online January 30, 2012.

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