Goods News About Hepatitis C

It seems there’s good news everywhere in the fight against Hep C. Firstly, the US congress has voted to lift the federal ban on funding syringe exchange programs after 21 years. Secondly, there has been some major breakthroughs for scientists in their search for an effective Hep C treatment. Two Australian researchers are responsible for one of the discoveries.

AIDS Activists Cheer End to Ban on Needle Exchange Funding
By Susan Sharon
MPBN

After two decades, Congress has voted to lift a ban on federal funding of needle exchange programs. AIDS activists are cheering the move, which they say legitimizes needle exchange as a weapon in the fight against HIV/AIDS.

For years, needle exchange programs in three dozen states have provided clean needles to intravenous drug users as a way to reduce the transmission of HIV/AIDS and Hepatitis C. But the programs have relied solely on state and local funding because of a longtime ban at the federal level, where some have regarded needle exchange as an incentive for drug addicts to continue to use.

"People have been afraid that this is going to conflict with some sort of zero tolerance policy," says Bill McColl, who is with the Washington D.C.-based advocacy group AIDS Action. He says the vote to lift the ban is a vote for science over outdated stereotypes.

"There are eight federal reports that show that syringe exchange will decrease HIV and Hepatitis," he says. "It doesn't increase substance abuse. You know, this is a real opportunity to do some serious outreach to a population that is often overlooked."

In some places, such as Maine, needle exchange rates have been on the rise. At the Eastern Maine AIDS Network, for example, about 4,000 dirty needles are swapped out for clean ones every month. Just three years ago, only 300 clean needles were given out monthly.

Observers credit a new director with effective outreach. But Maine has also had an increase in IV drug use. And Andrew Bossie of the Maine AIDS Alliance says that's why federal funding for needle exchange is so important -- as many as 12 percent of people being infected with HIV are getting infected by injecting drugs.

"So we're really very happy that the U.S. House and Senate have lifted this ban and that we're on our way to more sound policies that prevent the spread of HIV."

Though it's a rural state, Maine has four needle exchange programs which Bossie says are all facing funding problems. Around the country there are about 200. President Obama has previously expressed support for liftting the ban on federal funding of needle exchange as a way to reduce rates of infection.

And while his expected signing of the bill later this month won't guarantee programs get additional funding, activists say it could give more options to those affected by state and local budget cuts.


Liver-Targeted Drug Stops Hepatitis C
Durable DNA Molecule Blocks Hepatitis C Virus in Chimp Study
By Daniel J. DeNoon
WebMD Health News
Dec 2009

Hepatitis C virus can't get a grip on the livers of chimps treated with a new antisense DNA drug.

The drug, dubbed SPC3649, doesn't attack the hepatitis C virus (HCV) itself. Instead, it blocks the tiny RNA molecules in the liver -- microRNA-122 or miR-122 -- that the virus must use to make new copies of itself. HVC causes disease only when it can replicate to high liver concentrations.

HCV levels drop 350-fold in chimps treated with SPC3649, find Robert E. Lanford, PhD, of San Antonio's Southwest foundation for Biomedical Research and colleagues.

"The drug worked exceptionally well in treating HCV infections in chimpanzees," Lanford said in a news release. In an email to WebMD he said, "We were very excited with the outcome."

The researchers studied four chimps chronically infected with HCV genotype 1, the most common HCV strain in the Americas and Australia. It's also the most treatment-resistant HCV strain.

Two chimps got a low dose of SPC3649, and two got a high dose, given once a week for 12 weeks. The higher-dose treatment was remarkably effective in suppressing HCV. The lower dose showed a strong but lesser effect in one chimp, but not in the other.

As long as the animals stayed on the drug -- and for two weeks after treatment stopped -- HCV levels remained low. But after treatment ended, HCV levels eventually rebounded to pretreatment levels.

Treatment, however, made the virus much more sensitive to the antiviral effects of interferon. Interferon, combined with ribavirin, is the best current treatment for HCV, but only about half of people infected with genotype 1 HCV get long lasting control of the virus. It's hoped that SPC3649 could eventually be combined with interferon to give the virus a knockout punch.

SPC3649 targets miR-122 in the liver, where it plays a role in cholesterol metabolism. The only side effect seen in the chimps was a rather dramatic lowering of LDL (bad) cholesterol. In earlier studies with green monkeys, the drug had a stronger effect on HDL (good) cholesterol. That would not be a good thing if it happens in humans, but SPC3649 affects cholesterol differently in different primate species.

"I suspect that at some point lowering HDL too much would be a problem if you did not lower LDL at the same time," Lanford said in his email. "I do not suspect that this will be a limitation of this drug, but human clinical trial data are needed to address this issue."

That data is on the way. The drug's manufacturer, Santaris Pharma of Hoersholm, Denmark, has begun a phase 1 safety trial in HCV patients. Santaris funded the Lanford study and Santaris researchers contributed to the work.

Beyond HCV: LNA Drugs vs. Cancer, Inflammation, More
SPC3649 is actually a man-made strand of nucleotides, the building blocks of DNA and RNA. The drug is actually an antisense nucleotide, meaning that it is assembled in a way that makes it complementary to its RNA target.

Antisense nucleotides inactivate their targets. But normal nucleotides quickly break down in the bloodstream. SPC3649 uses a proprietary technology to lock it together so that it does not break down. Santaris calls this a "locked nucleic acid (LNA)-modified oligonucleotide."

The LNA technology is not unique to SPC3649. Santaris has used the technology to create LNA drugs for cancer, inflammatory diseases, metabolic diseases, and rare genetic disorders. These drugs are in various stages of preclinical and clinical development with various partner companies.

The Lanford study was published online in the Dec. 3 issue of Science Express.


Aussies Aid Hepatitis C 'Breakthrough'
NineMSN
Sep 2009

An Australian-led team of international medical researchers may have scored an important breakthrough in the treatment of hepatitis C.

The team, led by Sydney molecular geneticist David Booth and Sydney University hepatitis C expert Jacob George, has identified a variant in an interferon gene which links it to the treatment of the chronic hepatitis C virus (HVC).

The gene, known as IL28B, was found to encode an interferon "lambda" involved with the suppression of viruses, including HCV.

Interferons, or proteins inhibiting the replication of viruses, are identified through the use of letters from the Greek alphabet.

The researchers said the new study showed use of the interferon-lambda in treatment could benefit those people identified as best suited to receive it and spare others the cost and side effects of their current treatments.

Prof George said the current standard treatment procedure for chronic HCV was combined therapy with pegylated interferon-alpha and ribavirin for about 11 months.

"This treatment can have side effects and only about 40 to 50 per cent of individuals infected with HCV show a positive response to it," Prof George said.

"The current study renews interest in therapies which involve this type of interferon, and suggest that combined treatment with interferon-alpha and interferon-lambda may prove a more effective treatment."

Dr Booth, a molecular geneticist with Westmead Millennium Institute who is widely recognised for his work with multiple sclerosis and genes that cause autoimmune disease, said the same principles applied to hepatitis C infection as to MS.

"We inherit from our parents subtle differences in the make-up of our immune system that can make a major difference in susceptibility to disease or how we respond to treatment," he said.

"Finding each of the few genes that have such an impact gives science an edge in the eventual prevention or control of many of the major diseases of humankind."

He said the finding that inherited differences in the interferon lambda gene has such an impact on the treatment of Hep C provided a valuable new lead into beating "an infection of epidemic proportion worldwide".

Almost 300 million people are known to have been infected with hepatitis C, which is a leading cause of liver disease.

Results of the study into interferon IL28B were published on Sunday's Nature Genetics website.

Smoking Ban - Putting the Boot into Mental Health Patients

Anti-Smoking groups are applauding the NSW government's decision to remove a smoking exemption for mental health facilities. The obvious question is, will it help patients? A third of mental health sufferers and two thirds of schizophrenics smoke but under the government plan, they have to quit or abstain while they are being treated. Is it really a good idea to put this extra unnecessary stress on people already confronting intense personal issues? Although nicotine is physically addictive, it also has a huge psychological dependancy that can make it extremely stressful to quit.

As a smoker I know about the compulsory need to reach for a cigarette regardless of the harms. Kicking nicotine addiction is simply not possible for many including myself especially during a time of stress. I don’t care how many anti-smoking groups or loud vocal nay-sayers harp on, I find it virtually impossible to quit. The idea of quitting whilst dealing with a major issue in my life is even more distant and I am sure this is the same for most long term smokers. And what bigger issue could one have to deal with than going to a psychiatric centre for a mental health problem? I could only imagine one worse scenario than having to deal with a mental health issue at a psychiatric hospital ... having to quit smoking as well.

Like most people, I understand the need for smoke free environments and designated outdoor smoking areas meet this need. But in a mindless and stupid attempt to appease anti-smoking groups, the NSW government has taken a Zero Tolerance approach and banned all smoking in mental health facilities. The alternatives ... quit smoking. This is just what someone needs whilst dealing with probably the biggest issue in their life. What a bunch of shit-for-brains.

It has been found, rather surprisingly, that nicotine has beneficial effects on brain function in schizophrenia (American Journal of Psychiatry, 1993;150(12):1856-61). Normally, people are able to adapt to background noise and disregard it, for example while having a conversation in a busy street. Recordings of brain activity show that this ability is impaired in people with schizophrenia, so they are more distracted by the surrounding environment. When they smoke, or use nicotine gum or patches, brain function normalises and they are less reactive to irrelevant sounds around them. When the nicotine is taken away, the problems return. -The Australian: Mentally Ill Smoke More And Quit Less.

Has anti-smoking hysteria gone too far? I remember when the idea of banning smoking in pubs was so far fetched, I just knew it couldn’t happen. It was the same when they first touted the idea of banning smoking in restaurants ... and offices ... and public transport ... and ... etc. So times change and we get used to it. I just want to know where the line is. 

In The Netherlands where you can buy and smoke cannabis in licensed coffee shops, they have banned tobacco smoking. Is this just anti-smoking fever gone mad or does it make sense? I’m still thinking about that one but what doesn’t make sense is removing designated outdoor smoking areas. Considering smoking is highly addictive, you would think the authorities would be more realistic. So what’s their solution ... more smoking bans. 

It’s obvious that the balance between the rights of a smoker being able to light up and the need to keep everyone else free from smoke is failing. This is especially true when anti-smoking zealots start to threaten the well being of people like they have with mental health patients. Can you see a pattern here? A group of fundamentalists with certain beliefs, forcing their views on the public through manipulation of the government. A group that is so desperate, they will ignore any harm caused by their suggestions and continue to ruthlessly push their agenda. A group that brushes off expert opinion and ignores the people they are supposed to be helping in favour of their own unqualified views. 

The common denominator is drugs and this time it’s nicotine. And their target is the patient being treated for mental health problems. The fundies just cannot let an opportunity pass to force some poor unwilling sucker to suffer like hell. The patient be damned. Who cares if they are treated successfully? Who cares if they check out because they can’t quit smoking? Who cares if it discourages patients from seeking medical help? At least they won’t smoke for a few days.

Tobacco Ban Leaves Mental Health Groups Fuming
Sydney Morning Herald
By Louise Hall - Health Reporter
March 2009

A BAN on smoking in all psychiatric facilities will go ahead despite vehement opposition from some members of the mental health community, who argue that strict anti-smoking rules will destabilise acutely ill patients and put staff at risk of violence.

NSW Health has ordered all facilities, including emergency psychiatric centres, to close designated outdoor smoking areas, confiscate tobacco products and supply free nicotine replacement therapy to staff and patients.

Anti-smoking groups say the department's decision to enforce its longstanding smoke-free policy in wards that had been granted an exemption will help to break down the "deep-rooted smoking culture" among mental health staff and patients.

The new guidelines will be implemented over at least six months to give workers, patients and visitors time to adjust and, ideally, to quit their habit, with the help of counselling and anti-smoking aids such as patches and pharmacotherapy. The director of NSW Health's Centre for Health Advancement, Liz Develin, acknowledged there was widespread hostility to the ban but said research in Britain, Canada and other Australian states showed careful planning and education can lower levels of patient distress.

About one-third of people with a mental illness smoke, rising to two-thirds for people with schizophrenia, compared to about 17 per cent of the general population.

"Some consumer groups see it as taking away a person's right but everyone has the right to be in a smoke-free environment," Ms Develin said.

The chief executive of the Cancer Council NSW, Andrew Penman, said arguments that people with psychiatric disorders smoke to self-medicate or relieve symptoms, stress and anxiety "are too easily used as excuses to justify inaction about smoking".

There was weak evidence that smoking improves the neurological functioning of people with schizophrenia, he said. But many of these patients want to quit and can quit to improve their overall wellbeing.

A spokesman for the Mental Health Council of Australia, Simon Tatz, said forcing a nicotine addict to endure withdrawal symptoms while battling an acute episode of mental illness may impose a disproportionate level of suffering on people who were already suffering enough.

"No one wants to defend smoking, but when you're dealing with people in extreme crisis, their mental health and wellbeing has to be the priority, not quitting smoking," Mr Tatz said.

Desley Casey, who has worked in the mental health field for 15 years and has been an acute psychiatric inpatient several times, said forcing people to quit when they are acutely unwell is inhumane and "goes against a patient's human rights".

She is concerned that some patients will not seek help or admit themselves to hospital if they know tobacco is banned.

Ms Casey disagreed that NSW Health had a duty of care to break the cycle of smoking and disadvantage. "Is it their duty of care to put someone through terrible nicotine withdrawal symptoms during psychosis?

"I'm a smoker and I would prefer to risk the dangers to my physical health than risk my mental health, which is far more precious to me."

Internal NSW Health documents show hospital administrators have expressed concerns that patients may abscond or become increasingly agitated or violent if not allowed to smoke.

But "in some circumstances smoking may be permitted on a case-by-case basis" if nicotine replacement therapy does not work or where "refusal may pose a significant risk of violence to a staff member, patient or another person", the draft guidelines outline.

The chief executive of the Richmond Fellowship of NSW, Fred Kong, said mental health workers often used tobacco to bond or develop relationships with patients, which could help their recovery. "I'm fearful that applying this sanction will interfere with the therapeutic relationship between staff and patients," Mr Kong said.

A review of 26 bans in psychiatric settings worldwide published in the Australian And New Zealand Journal Of Psychiatry in 2005 found there was "no increase in aggression, discharge against medical advice or increased use of as needed medication" linked to smoke-free policies.

Although there has recently been a big push to help psychiatric patients quit smoking whilst in medical care, searching through the internet I have found plenty of criticism of forced smoking bans. Most of it comes from doctors and those involved in the day-to-day operations who’s only concern is the well being of the patient. Being medical professionals, they obviously understand the danger of smoking but pragmatism wins out over the rigid dichotomy between anti-smoking rhetoric and the real world of mental health services. 

Although there is growing evidence that patients can quit smoking whilst keeping their place in treatment, there is equal opposition from those who work on the ground, doing the actual work. Treating a mental health patient is already extremely complex and unless we have perfected it recently then introducing additional, non related and non critical goals, cannot make the task easier. The losers are the patients and as usual, those who don’t easily adapt to a new system are merely statistics and left to fend for themselves.

Stopping Mentally Ill People From Smoking Is Cruel
Sydney Morning Herald - Opinion: Letters
By Dr Alvaro Manovel Randwick
March 2009

As a doctor I strongly support anti-smoking policies. But there are specific issues relating to mental health patients that make the move against smokers by NSW Health deplorable ("Tobacco ban leaves mental health groups fuming", March 19).

Mental health patients may be voluntary or involuntary. Voluntary patients may simply stroll off the hospital grounds to smoke. But involuntary patients are detained against their will in hospital under the Mental Health Act and are not allowed that liberty.

They are by definition so mentally disordered that the last resort of the act has been invoked because they may be a risk to themselves or others. These patients are frequently agitated and smoking is one method they use to calm down. In this state they lack the capacity to consider the benefit of stopping smoking, and this is clearly not the time in their lives to introduce intransigent non-smoking rules that only escalate their agitation.

In the past these patients were allowed to go outside to smoke escorted by security staff, but since the introduction of smoking bans they may no longer do so. In hospitals all over NSW these poor individuals are being physically restrained and given sedative drugs when their agitation escalates. This infringes the spirit of the Mental Health Act, which stipulates that it may be invoked to detain a person only when there is no less restrictive means of doing so. Clearly allowing them to smoke is far less restrictive than physical restraint and sedation.

We already make these patients suffer protracted stays in crowded emergency departments, due to the failure of NSW Health to provide beds for them. It is easy to imagine what effect this has on individuals who are at the lowest ebb of mental wellbeing. To add insult to injury they are now told that their last vestige of self control - to seek solace with a smoke - is being withheld, in what must seem an arbitrary and cruel act by their carers.

Doctors are placed in the unenviable position of choosing to restrain the individual or to let them out on their own, with the risk they may abscond and harm themselves. What a sad state we have sunk to.

Related articles: Mentally Ill Smoke More And Quit Less

Diary: The Health System

DIARY: A short while ago, I had decided to apply for sickness benefits at Centrelink whilst I sort out some medical issues. This is because I wouldn’t be able to work for a few months and a regular income is essential. Sounds easy doesn’t it.

I have previously been on unemployment benefits for a few short periods and the only long period was when I was 17 and living away from home. The last time was about 8 years ago and after a few months I found a full time job which was a relief because Centrelink is HELL! I vowed never to return.

I thought the sickness allowance would be different though but there was a new problem ... my doctor! I like my doctor but his administration skills are poorly lacking. Problems usually involve his holidays where it is impossible to contact him or he doesn’t think through the needs of his patients.

Last time he went on holidays, he told me that another doctor would see me whilst he was away. When I turned up, the doctor knew nothing about it. Asking the doctor to ring the health department to authorise a permit for a month’s supply of morphine to a heroin addict was problematic enough but my 6 monthly authority had ran out as well. It finally was approved but it took an hour and the doctor was not happy. In a busy clinic, an hour for one patient means the other patients had to wait that extra time as well. As you can imagine, there were a few complaints.

 So now my doctor was going away again so I explained to him what happened last time. He said he had a better idea and told me to pick up a script in 3 weeks time which he would leave at reception for me. I did as I was told and went to the chemist as usual with the script he had pre-written. Easy. Then it all started again.

To avoid having to apply for a 30 day permit, my doctor had written 3 separate scripts for a lesser quantity to get me by until he returned in 13 days. The pharmacist (who I deal with every week) said the scripts didn’t say weekly pick up so I had to come in every day and pick up one days worth of medication at a time. He told me he knew what the doctor meant and it had always been a weekly pick up but there was nothing he could do. He suggested I ring the doctor’s clinic and get a letter authorising me to pick up weekly and until then I had to come in every day. I paid and left very unhappy.

Luckily the next day, another pharmacist told me that because we had been doing a weekly pick up for so long that he would use his discretion and allow me weekly pick ups. I asked why my regular pharmacist didn’t do the same and I was told that my regular pharmacist wasn’t sure because he wasn’t used to dealing with me. What could I say? He had ONLY been my regular pharmacist for 4 months.

But the worse was yet to come. I then had to pay for another 2 scripts as well. WTF?! So what was normally about $33 per month had to be paid 3 times ... for 13 days supply. Then when I next saw my doctor, I had to pay for another script. In total, I had to pay for 4 scripts for the month, 4 x $33. BTW, When I asked my doctor why the hell he wrote 3 separate scripts and thus 3 separate payments as well as the new script, he just shrugged and said, “oh well”.

 Back to sickness benefits. I had to resupply another medical certificate to replace an older certificate my doctor gave me, which had expired on Feb 10. I went to the doctor and he wrote another certificate. I then went to Centrelink a few days later and there were 60 people in the queue at 4.00pm. I was not going to be seen that day so I came back the next morning. After waiting 45 minutes in the queue I finally was attended to. After 15 minutes of phone calls and talking to other Centrelink employees, the person serving me said that my doctor had not filled out the dates properly so I would need to go back to him, get another medical certificate and return to Centrelink.

Oh dear god! I remembered why I vowed never to rely on Centrelink for income. Maybe I should have vowed never to return to my doctor?

Centrelink was surprisingly good without too many mistakes. It did take 3 months to get the right ID and forms filled out and they forgot to photocopy the back of some document. I wasn’t desperate for cash so it wasn’t too much of a worry. The problem is that I had to go to Centrelink 6 times so far and waiting in a queue for at least 30 minutes each visit. The other complaint is being told different things by different people. All this for $250 a week and a healthcare card. I suppose the healthcare card saves a bit considering all the medication I am on. Over all, I was happy with Centrelink. My real complaint is aimed at my doctor and the chemist. I have written about them before and I think somehow I will write about them again.

When you step back and compare the system I am complaining about to the US health and welfare system, I should count myself lucky. If I had been in the US, I would be homeless and a desperate junkie. Because of my drug history, I would be unemployable and not eligible for welfare housing. I would receive no income support and have to rely on charities for food. My SROM treatment would never had happened and I would not be able to afford methadone. A bleak picture indeed. The US mindset of avoiding “socialised medicine” at any cost is just unworkable ideology from the conservative elite. Leaving health to the business sector, insurance companies and big pharma has not worked out well for the US. For all the faults of our system, the main perpetrators that affected me were private businesses. The Medicare levy now seems like a very small price to pay.