Talk:Hepatitis C/Archive 2

NEJM

Most, if not almost all, of these articles are based upon old information that a blood test can distinguish correctly between patients with liver damage continuing and patients with no further liver damage. All of the articles that advance the idea of a "cure" or "cure rates" based upon blood-tests are inaccurate and as such, all of these should be removed or denoted as not measuring rate of change in liver organ scarring and/or death via a reliable test instrument.

I previously began this process but an editor erased all of my statements with the New England Journal of Medicene's Dec 2008 source that showed liver damage con't even when the blood work showed a reduced and/or undetectable levels of virus in the blood. In post-treatment patients, it is now acceptable to state that blood work does not equal a liver biopsy's results for determing the rate of change of growth or deterioration of the liver. Even when the blood work would allow for the idea of a "cure", liver biopsies showed liver damage continued. Thus, the blood work cannot and should not be allowed to be advertised as a successful "cure", i.e. all of those articles need to be repaired. As it stands, this article's information is misleading, misguiding, and wrong. —Preceding unsigned comment added by Slm1202000@yahoo.com (talk • contribs) 21:50, 3 September 2010 (UTC)

You are referring to doi:10.1056/NEJMoa0707615 (PMID 19052125). This study was done in a group of patients whose liver had already been extensively damaged by hepatitis. The "damage" you refer to is fibrosis, the deposition of connective tissue. The study showed that once fibrosis is extensive, eradicating the virus makes some changes on blood tests and even the appearance of the liver biopsy (histologic necroinflammatory scores), but that this did not translate into better outcomes. It is well known that chronic liver disease is a progressive disease - once a certain degree of damage has been done, it gets worse by itself even if you remove the cause. The same is encountered in alcoholics who have stopped drinking alcohol many years earlier, yet develop cirrhosis.

It may be appropriate to make it clearer in the article that treating hepatitis C does not necessarily undo any damage that has already been done. For this, we should ideally cite a secondary source that places the findings from this study in the necessary context. JFW | T@lk 21:09, 4 September 2010 (UTC)

JFW is 100% correct on this point; treatment of hepatitis C virus infections can eradicate the virus — at least below detectable levels by PCR— but does not always result in a full reversion of the damage to the liver. I agree, a secondary source is essential. Graham Colm (talk) 21:20, 4 September 2010 (UTC)

Agree cure of the virus just not cure of the fibrosis is possible. This article is about "chronic hepatitis C who do not have a response to antiviral treatment" not general people with Hep C.Doc James (talk · contribs · email) 23:06, 4 September 2010 (UTC)

Most trials following SVR patients indicate SVR is highly correlated with improved outcomes, even in those with advanced fibrosis. SVR does not guarentee complete histological reversal of damage, but does correlate with greatly improved outcomes. SVR attained prior to sever liver damage occuring typically results in progression of disease ceasing, and liver regeneration and recovery slowly occuring. The clinical picture of recovery is complicated by high levels of substance abuse of hepatotoxic drugs in study populations.Inteluck (talk) 03:46, 9 January 2012 (UTC)

Insufflation

On the face of it, it is not at all clear how transmission can occur through sharing drugs via insufflation. My understanding is that the use of very hot devices for vaporisation of, especially, crack cocaine or heroin (e.g. a soda can heated with a flame) can lead to burns around the nose and hence the possibility of blood transmission via shared equipment. However I am not expert in this area and perhaps someone with more specialised knowledge could comment and add to the article. —Preceding unsigned comment added by Pharmagiles (talk • contribs) 14:50, 9 November 2010 (UTC)

Five virus types known?

This article says that five subtypes of hepatitis are known (A, B, C, D, E) but the article Hepatitis D says that there are seven (F and G added). Please check references for these claims to avoid ambiguity. --Vitomontreal (talk) 23:59, 19 December 2010 (UTC)

I have restored Hepatitis D (removing reference to Hepatitis F virus and Hepatitis G virus as hepatitis viruses) because they are not hepatitis viruses at all, as those linked articles explain. -- Scray (talk) 04:23, 20 December 2010 (UTC)

HIV coinfection

This article should be linked to Hepatitis C and HIV coinfection 2.124.21.183 (talk) 08:51, 27 February 2011 (UTC)

Yes. HCV is rapidly getting out of control among the gay population, particularly in NYC. There should be much more discussion of transmission among the MSM population.Arlesd (talk) 20:09, 25 July 2011 (UTC)

Please add a ==See also== section, and add to that section a link to Hepatitis C and HIV coinfection. Thanks. 180.183.7.57 (talk) 22:40, 8 April 2014 (UTC)

 Done - Thanks for the suggestion - Arjayay (talk) 15:19, 9 April 2014 (UTC)

"SVR" is preferable to word "cure."

I've been reading the literature and don't find any journal articles claiming a "cure" for HCV. Instead, the desirable outcome is "sustained virologic response" or "SVR," meaning that virus is undetectable in the patient's blood six months after treatment. Of those who achieve SVR, 1-2% of them will relapse.

I have barely any WP editing experience, so for now will limit my contributions to the talk page.Cyclopiano (talk) 01:24, 3 March 2011 (UTC)

The pharmaceutical companies have now admitted that Hep C treatments of Interferon and Rebetol do NOT work. They are attempting another variation on this theme with a third drug added to the mix, which their white pages suggests may result in a 40% SRV rate. All of the 1-2% relapse rates are inaccurate. Anything reporting an 80% success rate is inaccurate. The New England Journal of Medicine reported that 0% were cured using these 2 drugs in Dec 2008 when patients were tested with true three core biopsies. The patients had to submit to more than one biopsy to begin with in order to be in the study, but the major requirement for them to begin the study was that a biopsy discovered that they had actually a form of Hep C. This is not really skewing the results, as I would not want patients with rheumatiod arthritis given radiation treatments for Hep C to ensure that a perfect control group exists. Any of the patients could have been cured. Now, even the pharmaceutical company admits the drugs do not work. It is erroneous to say there is a cure, but this article has in the past specifically spelled out that there WAS a cure. I am glad that the talk has shifted to SRV, but even here, there must be an update to allow that drug trials to find a continued SRV response are on-going. When it is suggested that only 1-2% might relapse, that in no way is taking into account all of the research that suggests otherwise that liver damage continued to exist in the liver even to the point of death.slm1202000 (talk) 13:45, 3 March 2011 (UTC)

SVR is currently most commonly correlated with triple therapy (PEG/RIB/TELEPRAVIR). SVR attained prior to severe liver damage occuring typically halts disease progression. If the virus remains undetectable for 12 months or more, the chance of spontaneous recurrence is extremely small, as is the prospect of liver damage. It is far more typical for those attaining SVR to reverse existing lver damage, and risks associated with HCV gradually diminish. For this to be considered a cure, all that is required is for more people to attain SVR. Present trials suggest it will soon be possible to attain SVR in 24 weeks or less in 80% of patients or more. I believe this could be considered a cure.Inteluck (talk) 03:57, 9 January 2012 (UTC)

Kissing?

The article states: "HCV is not spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils." but the provided source (http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#b1) never says anything about kissing "HCV is not spread by sneezing, hugging, holding hands, coughing, sharing eating utensils or drinking glasses, or through food or water."

Maybe I was not able to find the correct paragraph? — Preceding unsigned comment added by 91.113.6.100 (talk) 14:40, 28 August 2011 (UTC)

Public pools and hep c

If hep c cannot be contacted casually then why are public pools closed when there is an outbreak of hep c? — Preceding unsigned comment added by 64.130.132.43 (talk) 14:34, 23 September 2011 (UTC)

You are confusing hepatitis C with hepatitis A. Graham Colm (talk) 14:39, 23 September 2011 (UTC)

GA Review

This review is transcluded from Talk:Hepatitis C/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Muboshgu (talk · contribs) 15:44, 3 January 2012 (UTC) I'll be on vacation until the 8th (just checking in on the Wiki in a spare moment), so I won't be able to conduct the review for a few days. – Muboshgu (talk) 15:44, 3 January 2012 (UTC)

Thanks. --Doc James (talk · contribs · email) 07:31, 6 January 2012 (UTC)

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

   1a: Prose can be tightened in a few places. "For those that do manifest symptoms, they are in general mild and vague, including a decreased appetite, fatigue, nausea, muscle or joint pains, and weight loss" - here, the "they" is vague (are we talking about the infected individuals or the symptoms?). "The infection resolves spontaneously in 10-50% of cases being more likely in those who are young and females" is clumsy. "About 80% of those exposed to the virus develop a chronic infection,[6] with most experiencing minimal or no symptoms during the initial few decades of the infection[7] although chronic hepatitis C can be associated with fatigue.[8]" is a bit of a run-on sentence and should be broken in two. There are a few other places to improve prose, in addition to those. I'm not going to list them all, but a thorough review of the prose would be beneficial. Also, I just found a disambiguation link (now tagged in the article). I don't know where it's supposed to go, but it needs to be corrected.
   1b: Solid lead overall, which summarizes the entire article. No words to watch, fiction not applicable (though it would be nice if this was a fiction article), nor is lists. Regarding layout, however, some work needs to be done. One-sentence paragraphs are frowned upon, and this article has one-sentence sections. Those should either be expanded or merged as appropriate.

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   This is my first review involving WP:SCG. The article cites many sources, in many places where appropriate. Many of these sources come from high quality journals, and most of them were published in the last few years. There doesn't seem to be any original research here. However, the reference titled "Hepatitis Drug-Maker Complaints Reviewed" is a dead link and that needs to be replaced.

3. It is broad in its coverage.

   a (major aspects): b (focused):

   Most major aspects are covered. Regarding focus, I think the article's focus suffers due to some of the one-sentence sections I mentioned earlier. It would help to cover the major aspect of HCV in society/culture if that section were expanded.

4. It follows the neutral point of view policy.

   Fair representation without bias:

   No bias here.

5. It is stable.

   No edit wars, etc.:

   No edit warring here.

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

   All images are appropriate and have captions.

7. Overall:

   Pass/Fail:

   This is a well-written article that can meet GA standards with a little bit of work, as I outlined above. I'll put the article on hold for a week to allow for improvement (longer if work is in progress).

Reply

First of all many thanks for taking on this GAN.

• With respect to the disambig link. Pegylated interferon alpha is not really a disambig. I have thus removed the disambig tag from it as it is really a stub for a class of meds.
• I have added to the two section in question.
• I will see if I can get someone who knows prose to improve this. Doc James (talk · contribs · email) 23:38, 10 January 2012 (UTC)

• Well, pegylated interferon alpha may be the proper medical term, but on Wikipedia, Pegylated interferon alpha is a disambiguation page, and GA's can't link to a disambiguation page, so something has to give there. – Muboshgu (talk) 21:34, 12 January 2012 (UTC)

Yes it is no longer a disambig as the term does not mean multiple things.Doc James (talk · contribs · email) 21:58, 12 January 2012 (UTC)

Okay. That article could use some improvement, though that has nothing to do with this GA review. I'll take a look at it and see if I can do some of the copy editing and let you know where we stand. – Muboshgu (talk) 22:02, 12 January 2012 (UTC)

Source #48, "Chapter 4 — Hepatitis, Viral, Type C — Yellow Book, CDC Health Information for International Travel 2008" comes up as not found. – Muboshgu (talk) 22:10, 12 January 2012 (UTC)

thanks and fixed.Doc James (talk · contribs · email) 22:42, 12 January 2012 (UTC)

Great. I'm done with the copy editing, so I'll pass this on criterias 1 and 2 (except for 2b). I feel you've done enough to expand the article to meet 3a, which also took care of 3b. Where 2b comes in is that I added a citation needed tag in the Epidemiology section for a statement I feel needs to be sourced. If you add that, I'll pass this article. – Muboshgu (talk) 22:54, 12 January 2012 (UTC)

Sure that does not a ref. Do not understand how I missed it... Doc James (talk · contribs · email) 23:18, 12 January 2012 (UTC)

It happens to the best of us. Congratulations on your good work. I'm passing this as a Good Article. – Muboshgu (talk) 00:49, 13 January 2012 (UTC)

Vaccine Discovered

Apparently a vaccine HAS been discovered for Hep C.

http://www.bioresearchonline.com/article.mvc/Vaccine-Discovered-For-hep-C-0001

A quick google search also returns similar results — Preceding unsigned comment added by 68.230.183.82 (talk) 03:17, 22 February 2012 (UTC)

Yes exciting research. Not yet available though and would wish to see a better source before adding content on this in the research section.--Doc James (talk · contribs · email) 10:30, 4 March 2012 (UTC)

Here is an announcement from Feb 2012 from the University where the research was done http://www.news.ualberta.ca/article.aspx?id=B04932D68EF6488A8DE62A463FFA7487 scientifically, this means that it is now only a matter of time before a preventative vaccine is available, though that may be 5-7 years. This would be very helpful to note in the article - the way it's written now is just simply: none exists, and that is not reflective of this announcement. 70.36.197.239 (talk) 03:10, 5 April 2012 (UTC)

Yes so clinically none exists. Will be really exciting if one becomes available but none has at this point. The key is this bit here "that will potentially help combat hepatitis C" There is not evidence that it "does" just tentative evidence that it might in the future when more research is done. We do not base our content on press releases. Would like to see a review article. --Doc James (talk · contribs · email) 03:27, 5 April 2012 (UTC)

monogamous heterosexual couples.

"The majority of evidence supports there being no risk for monogamous heterosexual couples.[24] "

This sentence seems to support "monogamous heterosexual couples" but without actually saying anything. Maybe I'm missing something here but surely it's obvious that if neither partner is infected and they only have intercourse with each other there is no chance of them getting infected - however if the infection can be passed on by sexual transmission and if one of the couple is infected how does the fact that they are monogamous stop an infection passing between the two? Could you not equally write that the same sentence about, for example, lung cancer as there is no increased risk of lung cancer associated with being in a monogamous hetrosexual couple (nor for that matter being in a non-monogamous homosexual couple). I will for now remove this sentence. — Preceding unsigned comment added by 92.27.102.59 (talk) 16:15, 27 February 2012 (UTC)

Did you read what the source said? doi:10.1002/hep.23808 JFW | T@lk 18:53, 27 February 2012 (UTC)

Yeah I have now - I didn't have a chance to read it in depth at work earlier. I do see the point that is being made in the research but I think it is identifying risk factors rather than ways that the disease can be transmitted, except in the case of people infected with HIV and other STIs where sexual intercourse is a possible form of transmission. However I'm no expect and accept I may be entirely wrong! Broonsparrow (talk) 22:16, 27 February 2012 (UTC)

We are simply reporting what the best available literature states. There is something called serially monogamous heterosexual couples thus this is significant. One would not say this for HIV for example which is transmitted by serial monogamous relationships.--Doc James (talk · contribs · email) 10:37, 4 March 2012 (UTC)

Still this point is misunderstandable and should thus be clarified (referring to that transmission risk if one partner is infected does of course not change based on whether that's the only one one usually has sex with). --89.204.136.52 (talk) 14:46, 29 August 2012 (UTC)

Ambiguity?

'peginterferon and ribavirin are the current standard therapy'

Does this mean

peginterferon and ribavirin in combination is the current standard therapy

Or

peginterferon and ribavirin are the current standard therapies

Apologies for pedantry. It arises from ignorance and it's well-intentioned.

Notreallydavid (talk) 05:08, 5 March 2012 (UTC)

A combination. Thanks Doc James (talk · contribs · email) 06:07, 11 March 2012 (UTC)

Risk

Appears closest to 1:1,000,000 http://www.ccjm.org/content/77/9/616.long Doc James (talk · contribs · email) 10:44, 13 June 2012 (UTC)

Edit request on 24 July 2012

the sentence "This decreasing the risk from one in 200 units of blood[24] to one in 10,000 to one in 10,000,000 per unit of blood" in the "healthcare exposure" section, should be changed to "This decreased the risk from one in 200 units to between one in 10,000 to one in 10,000,000 per unit of blood", the reason being that that is the way it is expressed in English:) thanks in advance 80.39.195.133 (talk) 21:22, 24 July 2012 (UTC)

Hi, thank you for spotting this. I have changed the text as you suggested. Please consider creating an account and helping, when you have the time, to improve our articles. Graham Colm (talk) 21:30, 24 July 2012 (UTC)

Vitamin B12

I have removed the discussion of vitamin B12 recently introduced; there does not appear to be any reviews on PubMed when I looked up "Vitamin B12" and "Hepatitis C"; per WP:MEDRS and WP:WEIGHT, we do not use primary studies, but instead wait for appropriate secondary sources like review studies to discuss before including here. Yobol (talk) 15:45, 25 July 2012 (UTC)

The finding about B12 in the Gut paper was definitely an interesting one, especially since B12 is a very safe intervention. There are a few methodologic quibbles one could raise about the study (for example, they report a number of endpoints without, AFAICT, indicating which was the primary endpoint; it's unclear which subgroup analyses were pre-planned and which were post hoc; and the results in general are presented in a very confusing and difficult-to-interpret way), but I suspect the paper will generate a lot of interest. I do agree with Yobol that we should wait for this finding to be assessed and, ideally, replicated before including it in our article. We aren't and shouldn't be an according-to-a-new-study breaking-news service. MastCell ^Talk 16:05, 25 July 2012 (UTC)

Fair enough. Admittedly, I am new to WP:MEDRS and am happy to learn. Given the reported benefit of B12 for hep C treatment, though, hopefully someone will verify the findings soon. Regards, Cinosaur (talk) 16:12, 25 July 2012 (UTC)

No worries, and I apologize for the somewhat brusque responses. We should definitely revisit the issue once it's had a chance to percolate a bit. Cheers. MastCell ^Talk 16:28, 25 July 2012 (UTC)

Agree with MastCell and Yobol. It does take a little while to figure out how Wikipedia works. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 16:38, 25 July 2012 (UTC)

When you figure it out, please tell me. :P MastCell ^Talk 16:48, 25 July 2012 (UTC)

Me too. I've been around for a while, but Wiki Medicine seems to be a domain of its own. Regards, Cinosaur (talk) 17:09, 25 July 2012 (UTC)

Medical Treatment

Is it appropriate to talk about new medications being developed? I know that Bristol-Myers Squibb has some new drugs in clinical trials, [1], as does Abbott Laboratories [2]. Abbott's drugs are entering phase III trials, not sure about the BMS drugs. I don't really know how appropriate it would be to include, so I thought I'd just leave it on the talk page. Buddy431 (talk) 02:45, 24 October 2012 (UTC)

http://www.reuters.com/article/2012/11/10/us-liver-abbott-idUSBRE8A90B020121110 — Preceding unsigned comment added by 75.84.95.229 (talk) 07:54, 12 November 2012 (UTC)

came here to say the same thing. i'm currently at abbot in a clinical trial of an oral hep c medication about 4 companies have oral, non-interferon, meds in the trial stage. abbott's at least has been fast-tracked by the fda. 130.36.62.217 (talk) 22:48, 5 June 2013 (UTC)arbitraryaardvark

These are not treatments yet but ongoing research at this point. Yes we will discuss them when proper sources appear. See WP:MEDRS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:12, 5 June 2013 (UTC)

The Treatment/Medications sections needs to be re-written in light of new developments.Fconaway (talk) 13:08, 31 December 2013 (UTC)

Yes have updated with review articles. There is a lot of development under-way. Some of these are now available in the US. They are not available in many other regions of the world yet.Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:52, 31 December 2013 (UTC)

The content was however already mostly there. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:13, 31 December 2013 (UTC)

I came to mention the same thing previously mentioned: This is a well written article, however I am confused that sofosbuvir, simeprevir, viekira pack, and Harvoni have all been released but barely have a mention. These are DAAs that have been FDA approved and are currently being used by Hepatologists and Infectious Disease doctors across the US. Should the new DAAs be mentioned in this article, especially since they are approved and used by Hepatologists in the US? Furthermore the majority (>85&) of the patients treated with the new DAAs have reached SVR. I understand that these medications are not available around the world, however I feel they should get a mention in this article. Possibly a subheading under "Treatment" differentiating treatments available in the US, Canada, UK, etc and other countries around the world. <http://www.uptodate.com/contents/treatment-regimens-for-chronic-hepatitis-c-virus-genotype-1> Etvance (talk) 21:02, 24 July 2015 (UTC)

Both sofosbuvir and simeprevir are mentioned. We could create a subpage called Treatment of hepatitis C that goes into more detail on all avaliable agents. Doc James (talk · contribs · email) 22:44, 24 July 2015 (UTC)

Would it be possible to use a table similar to the one below, before we have Treatment of hepatitis C page? (By the way, genotypes 5/6 also take 12 weeks for sofosbuvir+ledipasvir combination (missing in the main body).)

The last two columns are just suggestion, but may help to quickly assess how old is a given medication, or maybe whether a given entry has more adverse effects. Initially, I wanted also to add effectiveness of a given combination, but since we are approaching 100%, I guess that would convolute that table (would be needed for every genotype.

Also, could we state right after that table (or that bullet list) that whatever is listed below has old (not too sure how to call it - not used anymore / not preferred / etc.) treatments? Whoever reads that section needs to somehow find out that the bullet list has the newest medications / combination of medications, as that is not that obvious reading that section.

Don't use this line, it is here to declare reference that is already in the main body.

Reference to HCV Guidelines

Drugs or drug combination used with respect to different Hepatitis C genotypes

	Treatment duration for a given HCV genotype (in weeks)							FDA approval date	Comments
HCV genotype	1a	1b	2	3	4	5	6
Medication or combination of medications
sofosbuvir+ledipasvir	12	12			12	12	12
sofosbuvir+ribavirin			12-16		24
sofosbuvir+ribavirin+pegylated interferon				12
paritaprevir+ombitasvir+dasabuvir		12
paritaprevir+ombitasvir+dasabuvir+ribavirin	12-24
paritaprevir+ombitasvir+ritonavir+ribavirin					12
elbasvir+grazoprevir	12	12			12
sofosbuvir+daclatasvir	12-24	12	12-24	12-24

I am not a registered user (don't want to be), so cannot make that change. 71.94.44.243 (talk) 01:29, 4 March 2016 (UTC)

The proper source for this information would be hcvguidelines.org, and determinants as important as genotype are missing from the table above including presence/absence of cirrhosis, prior DAA therapy, and resistance mutations (e.g. for grazoprevir+elbasvir, which is missing from the table above). With appropriate footnotes and other modifiers this could be done; not sure approval date is important enough to include in this table - could go elsewhere in the article. — soupvector (talk) 01:59, 4 March 2016 (UTC)

That table is taken verbatim from the existing bullet list in the main article. My intention was not to add new information, but rather to provide a tool to be able to quickly add new info (e.g., grazoprevir+elbasvir you mentioned). So, I would be happy to take your input, and extend the table the way you suggest.

I added the approval date (can be any date to roughly indicate when given drugs/combinations were introduced), as while reading that section, it was not obvious to me that treatments described right after that list are potentially obsolescent. I started to convert that next paragraph to a table format as well, and only realized that it is an old info after touching references.

On the other hand, maybe we should think who are the majority readers for this article. I would lean toward the suggestion brought by Doc James, that we should think about creating a separate page, where we could have better explanation, and keep in this article only a basic info. 71.94.44.243 (talk) 19:20, 4 March 2016 (UTC)

Actually, looking at the link you provided, it would be quite easy to include presence/absence of cirrhosis in the table (just split genotype columns). On the other hand, looks like other determinants may be more given combination specific, so it would be easier to keep those in the 'Comments' section. If you are OK with that, I can modify the above table, and also list treatments from that link. To some extent, it may be good to add one more column that would state whether a given combination is recommended or not (based on that link). However, I am not sure whether recommendation from that link are good enough to bring it to this table. 71.94.44.243 (talk) 19:25, 4 March 2016 (UTC)

I compared treatments for 1a genotype listed on the page you provided. Based on that, I would suggest not including any new determinants. It looks to me that a given combination can be used for all determinants. The difference that I see is in treatment duration (e.g., 12 vs. 24 weeks). Of course, some combinations are recommended for a given determinants set, the same combinations are marked as alternative for the other sets. What it implies to me is that those marked with alternative may have not as good efficacy, but can still be used. On the other hand, maybe those with lower efficacy are the only available in a given country, or maybe are less expensive than recommended, etc. Therefore, I would only bring new combinations to the above table, and if we agree, replace that bullet list with that table. 71.94.44.243 (talk) 02:17, 5 March 2016 (UTC)

Query undue weight

Have removed the following due to its reliance on popular press sources and what appears to be more or less a blog. The description of phase two trials is generally not notable IMO. Would need a proper review article to put things in perspective. New sources usually blow things out of perspective.

In 2012, Dr. Mark Sulkowski of the Johns Hopkins University School of Medicine described a Phase II research protocol using a combination of two new oral medications, daclatasvir and sofosbuvir, with none or few side effects. According to the study, the cure rate (SVR) for genotype 1, 4, 5, or 6 hepatitis C patients after 12 weeks of treatment was 93%. However, the medications are produced by Bristol-Myers Squibb and Gilead Sciences respectively, and Gilead has ceased collaboration with Bristol Myers on the protocol, which means that the regimen cannot proceed to Phase III trials and cannot be approved by the FDA. In February 2103, a petition to the White House was created demanding that the US government intercede to force Gilead and Bristol-Myers to continue research on the protocol.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:48, 21 March 2013 (UTC)

A few more interesting points "This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal." The trial involved 44 people. The "expert" comment works for the manufacturer.Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:50, 21 March 2013 (UTC)

OK, so maybe there's a disconnect here. Wikipedia is not a peer-reviewed journal, nor a scientific paper publication medium. It's a gazetteer. We gather information from various sources, within our guidelines and policies, and we put them up for the world to see. Now, this study, preliminary as it might be, has received enough significant coverage in independent, secondary sources. Thus my estimation that its mention merits inclusion. Ignoring for a second the whole petition thing (which is relevant since it's tied to the notability of the topic, but still), I'm trying to understand just what it is all of you working on this article are trying to accomplish. I'm not attempting to insert info about some quack study covered by fringe blogs, this is from the Perelman School of Medicine at the University of Pennsylvania. So what is the problem, exactly? §FreeRangeFrog^croak 00:58, 21 March 2013 (UTC)

OK, so what you're saying (and let's please keep it here) is that because this information does not come from a review journal, it is not acceptable? Is that the issue? §FreeRangeFrog^croak 01:01, 21 March 2013 (UTC)

Yes. When it is discussed in a review article I will than support its inclusion. It is to early. The study has not been put into proper context yet. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:28, 21 March 2013 (UTC)

I strongly disagree that this information does not merit inclusion simply because it's not referenced by a source of a specific type that this article as a whole does not seem to strictly require. Nowhere in the applicable guidelines (which are also created by consensus) do I see that all data in an article like this one must adhere to that sort of lofty standard. We are not talking about a fringe theory, the wacky blog of the week, or defamatory material in a biography. I appreciate that any reference article is keen on verifiablity and quality of sources, but there's a definite problem when properly sourced and obviously notable information that could be useful to people who use Wikipedia as a starting point for research is deemed unworthy because of that. Ultimately it doesn't really matter what you or the other active editors of this article think about the information, how many participants were involved in the trial, or its validity. It also doesn't matter what I care or prefer. What is important and relevant is that there are enough secondary reliable sources that considered it worthy of significant coverage. That is the point of view that you seem to be missing here. §FreeRangeFrog^croak 02:46, 21 March 2013 (UTC)

What it is is an overly optimistic interpretation of a small preliminary research study by the popular press which has not been repeated or put in proper perspective by a high quality source. I propose we wait until the proper perspective exists. This was also the meaning of the comment by JFW. there is no consensus for its addition. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:00, 21 March 2013 (UTC)

Apologies for not weighing in earlier. Wikipedia, due to its "real-time" nature, needs to have real guidance and parameters about what constitutes a major advance in medical science. A small positive phase II study might be absolutely fascinating for scientists in the field, but for the vast majority of the readers it is utterly irrelevant, mostly because the treatment is still several years away from being used in practice if it doesn't die somewhere along the way from reports about adverse events. If we were to include these studies now, the article would be highly inaccessible to readers who want to know how hepatitis C is treated currently, and it would be giving false hope if the treatment is ultimately found not to be succesful.

The above has led the medical editors of Wikipedia to formulate WP:MEDRS, which attempts to strike a balance. JFW | T@lk 09:46, 24 March 2013 (UTC)

NEJM

doi:10.1056/NEJMra1213651 - therapies for hepatitis C. Could be for current and future treatments. JFW | T@lk 22:24, 16 May 2013 (UTC)

Addition of primary research

This primary research keeps getting added "This condition is also associated with sudden death. Templeton2009>Templeton AH, Carter KL, Sheron N, Gallagher PJ, Verrill C (2009) Int J Environ Res Public Health 6(12):3070-81. doi: 10.3390/ijerph6123070 The mechanism is not known." Wondering what peoples thoughts are? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:20, 20 July 2013 (UTC)

This is a misguided synthesis. That article states, "The presence of steatosis at post mortem is a sensitive test of high consumption of alcohol", i.e. they are using it as a marker of high alcohol intake, not as the proximate cause of death. The Introduction states, "The mechanism of death is not fully understood, but thought to be due to a variety of metabolic disturbances triggered by massive ethanol intake and starvation resulting in cardiac arrhythmia." Underscoring this is the third paragraph of the discussion, which discusses mechanisms of death in these people, not one of which is liver disease per se - all relate to the effects of alcohol, with an emphasis on cardiac causes (i.e. the usual culprit in sudden cardiac death, which is arrhythmia) as a result of electrolyte disturbances. The last sentence of the first paragraph of the Discussion says, "Based on this study, alcohol related arrhythmia potentially accounts for 1,150 deaths in England and Wales each year." Overall, this is a great example of correlation does not imply causation - fatty liver was used as a surrogate measure of alcohol consumption (which is otherwise very hard to measure due to variation in self-reporting), with alcohol being the most likely proximate cause of death. There is no evidence basis for suggesting that fatty liver in persons with HCV carries a similar risk of death (except when the HCV-related fatty liver is attributable to concomitant alcohol use). -- Scray (talk) 23:26, 20 July 2013 (UTC)

Yes exactly. And it is a primary source aswell. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:36, 20 July 2013 (UTC)

Agreed - neither the source nor the synthesis is appropriate. -- Scray (talk) 23:47, 20 July 2013 (UTC)

Steatosis has been recognised as a cause of sudden death since 1926. The increased risk of death appears to be related to the presence of the steatosis rather than to its cause per se. Although in the majority of cases the cause of the steatosis has been attributed to alcohol, sudden death has occurred in the absence of alcohol. The same scenario been reported in children and steatosis is also recognised cause of sudden death in children (5-10% of cases). When these cases are investigated further the majority of cases in children appear to be due to disorders of fatty acid metabolism. The underlying mechanism of death in the presence of steatosis is not known but is thought to be due to cardiac arrhymthias. This in turn may be due to the presence of an as yet unidentified cardiac toxin produced by the diseased liver or one that has not been detoxified by the liver due to its diseased state. An alternative hypothesis that has been proposed is that the steatosis induces changes in the right ventricle which then become arrhymogenic. Abnormal arrhythmias have been recorded in the presence of steatosis. For once electrolyte disturbances ('the usual suspects') do not appear to be responsible.

Concerning the correlation and causation comment above: I concur entirely. The risk of sudden death correlates with the presence of steatosis. The cause of the steatosis is not known with any certainty in many (possibly the majority) cases and attributing it entirely to alcohol is likely to be a mistake given that the range of infectious diseases, toxins and metabolic disorders is wide and only a fraction of these are looked for in a typical post mortum. For example if steatosis or cirrhosis is present at post mortum and there is a history of alcohol abuse viral or metabolic screening is rarely done. Alcohol histories (like food histories) are very unreliable and it is likely that many of these cases are not due to alcohol. DrMicro (talk) 07:13, 21 July 2013 (UTC)

If one primary reference doesn't support something adding three more primary sources doesn't fix it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:02, 21 July 2013 (UTC)

• In addition to the quality-of-sources problem, you're misinterpreting the literature. For the reasons I summarized above, the Templeton paper clearly implied that steatosis was a measure of heavy alcohol exposure, and that heavy alcohol exposure increases risk for sudden death. It doesn't matter (in the WP context) if you think they're wrong; what matters is what we find in reliable sources (of which Templeton is not one in this article's context). -- Scray (talk) 17:10, 21 July 2013 (UTC)

The logic in the statement above does not make sense. The authors did indeed suggest that alcohol is the most likely cause. They also stated that there are many cases reported where there was NO alcohol present in the body at the time of death. It is difficult to attribute a cause of death to alcohol when none can be detected. It is also clear from a reading of the paper that tests for viral and other metabolic tests are not commonly carried out. The authors are only proposing that alcohol is the cause of the steatosis but have not proven it one way or the other. It is a known fact that the only finding in a number of cases of sudden death is steatosis. It is not known why this association occurs: this is just a fact. There are a LOT of pathologists would like to know why this happens. It is also a fact that arrhymias are more common when steatosis is present. This has been shown with ECG monitering during life. The mechanism again is not known. What is known is that a prolongation of the QT interval in the presence of cirrhosis may occur. This change does not appear (as far as I know) to occur in steatosis. The mechanism of prolongation of the QT interval is not known either. It is suspected that a cardiac toxin may be responsible for both but this is speculation at present. DrMicro (talk) 22:03, 21 July 2013 (UTC)

Alcohol levels are notoriously poor measures of alcohol exposure due to its short half-life and variation in metabolism (so its absence is of little value). That's why Templeton et al used liver pathology as a measure of alcohol exposure. If you don't understand at this point, I give up. -- Scray (talk) 22:49, 21 July 2013 (UTC)

Like yourself I am aware that alcohol has a variable half life. However in attributing a cause of death directly to alcohol requires the drug to be present. That alcohol may have an effect on an organ that then malfunctions and the malfunction of the organ then causes death is a different statement. Perhaps if you consider the following hypothetical example. Eggs contain cholesterol. Too mcuh cholesterol may cause coronary artery disease. Rupture of the atheromatous plaque may then lead to thrombosis and death. Here we could say that eggs caused the death. Alcohol is a recognised cause of death. It may cause death by respiratory depression, inhalation of gastric content or a direct effect on the heart. However to be a direct cause of death it must be present at the time of death and at a sufficient quantity to cause death. It is otherwise at best an indirect cause via its actions on one or more organs. How these pathological changes then cause death is the subject of considerable speculation and research.DrMicro (talk) 23:20, 21 July 2013 (UTC)

The problem is that steatosis like cirrhosis and other conditions may be due to a multiplicity of causes. For example acute fatty liver or pregnancy - a condition that is sometimes fatal - is not commonly due to alochol but that to previously unrecognised fatty acid metabolism defects exposed in late pregnancy. In the absence of biochemical studies this condition may be ascribed to alcohol abuse. Most post mortums do not look for biochemical evidence of fatty acid metabolism disorders where there is a history of alcohol abuse.DrMicro (talk) 23:04, 21 July 2013 (UTC)

"The association between fatty liver and sudden death has long been suspected particularly in forenics pathology..." - This doesnt come much clearer than that. This is simply a fact.DrMicro (talk) 22:06, 21 July 2013 (UTC)

Here is another paper stating the same thing - from from 30 years ago: Randall B (1980) Fatty liver and sudden death. A review. Hum Pathol 11(2):147-153.DrMicro (talk) 22:12, 21 July 2013 (UTC)

And another paper stating the same thing: Kuller LH, Perper JA, Cooper M, Fisher R (1974) An epidemic of deaths attributed to fatty liver in Baltimore. Prev Med 3(1):61-79 DrMicro (talk) 22:23, 21 July 2013 (UTC)

Piette M, Lambrecht E (1981) Liver steatosis and sudden, unexpected death. Arch. Beig. Med. Soc. 39:306–314

How many of these cite HCV as a cause? Alternatively, are you just stitching the associations together in a reasonable way? -- Scray (talk) 22:49, 21 July 2013 (UTC)

Since the review is dated to 1980 - nine years before Hep C was discovered - the authors might have a problem citing Hep C as a cause. As to stitching associations - that I am not. I am merely stating a fact known for over eight decades. I have not stated that Hep C causes sudden death. What I have stated is that steatosis is associated with sudden death and this may be the only pathological finding in such cases. That is all. Whether the steatosis associated with Hep C is or is not especially associated with sudden death I do not know. Nor does anyone else I suspect. I may be wrong but I think that is the particular question you have in mind. If in your mind you have associated Hep C with an increased risk of sudden death that may be stitching associations. It is known that persons infected with Hep C do have an above average rate of death from all causes including sudden death. Whether this increase is due to the steatosis is I think an open question. It is I think a possible and even plausible association but one I am not not aware of any evidence for or against. Perhaps you known of a ref that supports or refutes this possibility? What I do know is that some people with Hep C drink excessive amounts of alcohol and that this practice is associated with the development of steatosis, stetohepatitis and cirrhosis at a higher rate than those that do not.DrMicro (talk) 23:04, 21 July 2013 (UTC)

Please have another look at the first sentences at WP:SYNTH, i.e. Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources. If one reliable source says A, and another reliable source says B, do not join A and B together to imply a conclusion C that is not mentioned by either of the sources. -- Scray (talk) 23:26, 21 July 2013 (UTC)

With due respect where have I stated that Hep C is associated with sudden death? I have stated a fact. I have not drawn a conclusion from this fact or any combination of facts on this page. If there is any synthesis occurring here it is not I that is doing it. If you are concluding that Hep C is associated with sudden death then it is possible that you may be correct. I cannot say that you are or are not correct.DrMicro (talk) 23:41, 21 July 2013 (UTC)

We have had a bunch of primary sources add to support this. Also consensus is that med hypotheses is not a reliable source. "Steatosis is also associated with sudden death.

• Templeton AH, Carter KL, Sheron N, Gallagher PJ, Verrill C (2009) Int J Environ Res Public Health 6(12):3070-81. doi: 10.3390/ijerph6123070 (a retrospective study)
• Lazo M, Hernaez R, Bonekamp S, Kamel IR, Brancati FL, Guallar E, Clark JM (2011) Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ 343:d6891. doi: 10.1136/bmj.d6891 (comparative study)
• Xu XK (2004) Right ventricular fatty replacement as the possible missing link between fatty liver and sudden death. Med Hypotheses Res 1:253-260(Med Hypotheses)
• Chejfec G (2001) Fat replacement of the glycogen in the liver as a cause of death: seventy-five years later. Arch Pathol Lab Med 125(1):21-24 (comment piece/historical article)

With due respect I have trouble reconciling this last statement with the section "HEPATIC STEATOSIS AND SUDDEN DEATH" in the paper which reviews the literature over several decades.

The mechanism is not known. This is unreffed "

This is - as far as I am aware - a statement of the current state of knowledge. If you do know the mechanism and can find a reference I for one would love to read it.DrMicro (talk) 22:40, 21 July 2013 (UTC)

The only review article used is the following and it does not mention "sudden death" in relation to steatosis.

• El-Zayadi, AR (2008 Jul 14). "Hepatic steatosis: a benign disease or a silent killer". World journal of gastroenterology : WJG. 14 (26): 4120–6. PMID 18636654. {{cite journal}}: Check date values in: |date= (help) (review article)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:13, 21 July 2013 (UTC)

As noted above this last is an incorrect statement.DrMicro (talk) 22:40, 21 July 2013 (UTC)

A 1980 review I not acceptable. Which line in the El-Zayadi review supports the text in question? Please read WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:22, 21 July 2013 (UTC)

A reasonable question is why would such a review not be acceptable? These papers are only stating facts that have been known for decades. And for a more recent review see the section mentioned above in Chejfec G (2001) DrMicro (talk) 23:27, 21 July 2013 (UTC)

As you probably noticed in Templeton et al noted that the association between sudden death and steatosis has not been reviewed in the English literature for several decades. The authors were unaware of why this should be the case. For this reason it is not easy to find recent reviews in the English literature. DrMicro (talk) 23:36, 21 July 2013 (UTC)

WP:MEDDATE:"These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published." I think that covers the position here. For reasons unknown there have been few reviews of the association between steatosis and sudden death in the English literature for some time.DrMicro (talk) 23:50, 21 July 2013 (UTC)

If you wish to question WP:MEDDATE, please don't do that here. This talk page is about the Hepatitis C article. -- Scray (talk) 23:33, 21 July 2013 (UTC)

Fair point. DrMicro (talk) 23:36, 21 July 2013 (UTC)

So if there is no review in the last 10 years that mentions the association of steatosis and sudden death in relation to hep C maybe we should simply leave it out until such time it does? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:19, 22 July 2013 (UTC)ee

Agree it should be left out. Theories change and given the large number of up-to-date review articles covering Hep C I see absolutely no reason to bend the MEDRS rules to allow inclusion of poorly-sourced content or synth. Why not just let the sources lead us to the content? I don't understand the reason for what appears to be reaching to include this questionable content. If it were an important part of up-to-date research it'd be clearly stated as such in (probably multiple) reviews. The fact that it's so hard to piece together sourcing for the proposed content indicates it probably shouldn't be included. Zad68 03:06, 22 July 2013 (UTC)

Leave it out until/unless a secondary review mentions it: stitching together primary sources is UNDUE and OR. SandyGeorgia (Talk) 10:44, 22 July 2013 (UTC)

″==I do not get it== Why does DrMicro keep duplicating the content in the article. He adds " Steatohepatitis normally occurs before cirrhosis develops" when one line before we already state "Fatty changes to the liver occurs in about half of those infected and usually present before cirrhosis develops" Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:04, 22 July 2013 (UTC)

This is simply corrected. Steatosis and steatahepatitis are two distinct pathological entities. Steatosis appears to be relatively benign. Steatahepatitis is much less so. They are distinguished by the degree of inflamation present. Conflating them into a generic term 'fatty change' is IMHO a mistake.DrMicro (talk) 00:21, 22 July 2013 (UTC)

If you agree that steatosis and steatahepatitis are indeed distinct entities and that the usual order of progression is from steatosis to steatohepatitis, to avoid further pointless edit warring would you please be so kind to rewrite the section. DrMicro (talk) 00:37, 22 July 2013 (UTC)

This is still not a review article http://www.ncbi.nlm.nih.gov/pubmed/?term=Fat+replacement+of+the+glycogen+in+the+liver+as+a+cause+of+death%3A+seventy-five+years+later Were is the consensus that this primary source supports the statement in question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:05, 22 July 2013 (UTC)

We have a third opinion that was not supportive. I guess it may be time for a RfC? This paper is about ETOH not hep C. It does not even mention hepatitis C once. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:08, 22 July 2013 (UTC)

With all due apologies to all concerned

(1) the part of Meddate seems applicable here so the grounds for rejecting the 1980 and 1974 reviews seems questionable

(2) On what grounds does Jmh649 state that the 2001 article is not a review? I have read the article. It reviews the literature over the previous 75 years. It notes that several authors have made precisely the same factual finding. Maybe there is a difference of opinion here over what is and is not a review.

I believe that it is a review because (a) it contains no original research and (b) it reviews the literature over the previous 75 years. It does include a historical section but many reviews do. I conceed that I may have misunderstood the nature of a 'review' as used on WP. If so I would be most grateful to be enlightened as I will not make this mistake again.DrMicro (talk) 00:18, 22 July 2013 (UTC)

If you go to pubmed [3] you can click on publication type and it is listed as a comment / historical article. And then if you go to the full article in question it does not mention hepatitis C[4]. This article is not about alcoholic hepatitis. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:22, 22 July 2013 (UTC)

I prefer to read the articles rather than rely on the classification given by Pubmed. The article in 2001 I agree does not mention Hep C. However it does mention the connection between steatosis and sudden death. Steatosis is the result of a number of pathological process including but not limited to alcohol. The article in 2009 notes that reasons unknown that there have been no reviews in the English literature on this topic for several decades. The authors do not appear to know why this is so. As noted above the 1980 and 1974 reviews would seem to fall under to fall under the exception noted in Meddate. It may be worth noting in passing that it does not mention any connection between steatohepatitis and sudden death. DrMicro (talk) 00:31, 22 July 2013 (UTC)

A quick look at PubMed with MeSH term "Hepatitis C" shows over 1,800 review articles in the last 5 years. This is a very well-studied area, there's no reason to use anything other than up-to-date review articles and textbooks. The 2001 historical comment (not a review article) used in this edit to support present-tense statements in Wikipedia's narrative voice ("Steatohepatitis normally occurs before cirrhosis develops. Steatosis is associated with sudden death.") isn't acceptable, in my opinion. It's not even clear how relevant it is. Zad68 03:00, 22 July 2013 (UTC)

I agree it would be pointless to cite an article about steatosis that doesn't mention hepatitis C. That is, unless there is consensus that it enhances the article. At the moment, no such consensus exists. JFW | T@lk 07:13, 22 July 2013 (UTC)

WP itself notes the difference between steatosis - deposition of fat in the liver without inflation - and steatohepatitis - a condition characterized by inflammation of the liver with concurrent fat accumulation in liver. Neither is a specific clinical conditon but rather a histological term for an entity that can occur in the course of several diseases. It is considered highly unlikely that cirrhosis can develop in the absence of inflation. This is because cirrhosis is an organ specific response to chronic inflation (scarring). Not all cases of steatosis develop into steatohepatitis. The accepted progression order is steatosis <=> steatohepatitis -> cirrhosis. Only the final stage (cirrhosis) is regarded as irreversible (hence the one way arrow). This pathological process occurs in Hepatitis C. Perhaps I am missing something here but I would have thought a pathological process with histologically defined steps that does occur in Hep C is relevant. If I am missing something here I would be grateful if some one could explain it to me. DrMicro (talk) 07:24, 22 July 2013 (UTC)

The main problem here is sourcing. In addition to making claims that are unsupported by the literature, you're saying things that are directly refuted; for example, you say that cirrhosis is "irreversible", yet reliable sources clearly indicate that successful treatment for HCV is associated with regression of cirrhosis (e.g. PMID 23286846, PMID 22212581, PMID 21427396, PMID 20714001). -- Scray (talk) 11:38, 22 July 2013 (UTC)

I am not aware that cirrhosis is reversible. There is a problem with sampling of liver biopsies which may cause the apperance of reversibility. I am not aware that scar tissue in any organ can revert to normal. If this is the case then the plastic surgeons will be delighted. The only case where I am aware of non formation of scar tissue in healing in the fetus. This is an area of considerable interest both to the plastics and other specialists.DrMicro (talk) 13:17, 22 July 2013 (UTC)

Of the four sources cited (PMID 23286846, PMID 22212581, PMID 21427396, PMID 20714001) only one - the third - makes a claim for reversal of fibrosis. This is on liver biopsy which is known to be prone to sampling error. It is probably more accurate to say that treatment is associated with stabilisation and prevention of new lesions than genuine reversal of the fibrosis. Any treatment that would reverse fibosis would be very welcome: thinks scleroderma or pulmonary fibrosis for only two examples. DrMicro (talk) 13:28, 22 July 2013 (UTC)

DrMicro, Scray brought four recent MEDLINE-indexed review articles: PMID 23286846 states "Treatment with pegylated interferon and ribavirin (PEG-IFN/RBV) has clearly shown the benefits of successful treatment by improving fibrosis, causing the regression of cirrhosis and reducing and preventing cirrhosis-related complications.", PMID 22212581 (same lead author) states "Treatment with pegylated-interferon (PEG-IFN) and ribavirin (RBV) (PR) has definitely shown the benefits of successful treatment by improving fibrosis, causing the regression of cirrhosis and reducing and preventing cirrhosis-related complications.", PMID 21427396 states "Seven studies have shown that regression of HCV-related cirrhosis is possible", PMID 20714001 is titled "Treatment of HCV infection in patients with cirrhosis." In response you state "I am not aware that cirrhosis is reversible" and you question the sources based on your own views of study techniques. Based on this I'm concerned that your editing direction is to base article content on what you personally believe and not what up-to-date reliable secondary sources say. Will you agree that we need to be basing article content on reliable sources and not our own views? Zad68 13:36, 22 July 2013 (UTC)

There appears to be a conflation of terms here: 'regression' is not the same as reversal. As I understand it cirrhosis is the end process of the combination of liver regression and fibrosis. If the liver is allowed to recover without the development of new fibrosis the proportion of fibrotic tissue on a liver biopsy appears to fall (regress). The fibrosis is not reversed but is rather prevented from worsening. Of course it is possible that editor Zad is aware of some reliable secondary source that states that fibrosis is reversible with anti Hep C treatment. If Zad is aware of such sources it is curious why these have not been included in the article.DrMicro (talk) 21:48, 25 July 2013 (UTC)

Agree with DocJames, Scray and Zad68, we should be building this article with secondary sources, not primary ones. The focus on primary sources leads to undue WP:WEIGHT being placed on certain aspects of the disease. Yobol (talk) 17:26, 22 July 2013 (UTC)

Occult infection section

The occult infection section may provide undue weight. What do high-quality secondary sources have to say? I will try to look into that, but I wonder if other editors have a sense of this. -- Scray (talk) 14:23, 27 July 2013 (UTC)

I took a look at it tonight and the current content is supported by at least four MEDLINE indexed review articles that cover the topic. Seems appropriate to me, IMHO. If anything to adjust the weight maybe a bit more could be added to the other subsections parallel to it? Current content could use a bit of trimming and copy editing. Zad68 03:54, 29 July 2013 (UTC)

HCV half-life

Based on therapy with more-potent agents, the half-life has been revised - the current estimate is 45 minutes: PMID 23431163 and PMID 23516348. Though the sources are primary and share some authors, they are extremely reliable, uncontested in the field, and in keeping with secondary sources. Nonetheless, because this is primary-sourced I'll let others decide whether to use this to update the article. -- Scray (talk) 18:55, 29 July 2013 (UTC)

Found a secondary source and added. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:57, 30 July 2013 (UTC)

Which subpage?

I was curious about this edit because I didn't see any hits in Special:Contributions/Jmh649. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 09:23, 29 October 2013 (UTC)

If you look at that section you will see a main template. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:07, 29 October 2013 (UTC)

Ah, HCV in children and pregnancy, which is quite small. Couldn't it be summarized and merged here? I dislike unnecessarily dividing our efforts across multiple articles. I considered making a causes of deep vein thrombosis article but decided it was against our best interests, for what it's worth. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 10:46, 29 October 2013 (UTC)

I am of the opinion that the main articles should be keep fairly short and focused. See obesity for example. We have one section on obesity in children that link out to a page on the topic. Pediatrics is an entire specialty. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:12, 29 October 2013 (UTC)

I like the best of both worlds. I think DVT is short but also doesn't split out. ;-) Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 11:28, 29 October 2013 (UTC)

Bot switched off?

Bot switched off ⇒ no edit made to the article or its citations.

Duplicated citations have not been simplified.

Changes needed: Add: pages, pmc, issue, last1, first1, author6, series, isbn, volume, first2, first3, first4, first5, first6, first7, first8, first9, first10, first11, first12, first13, first14, first15, first16, first17, first18, first19, first20, first21, first22, first23, first24, first25, first26, first27, first28, first29, first30, pmid, year. Tweak: page, pages, title, doi, pmc, last1, first1, last2, last3, last4, last5, author6, isbn, volume, first2, first3, first4, first5, first6, first7, first8, pmid, year. Combined duplicate references. Formatted dashes.

These errors need to be corrected!Fconaway (talk) 07:19, 7 November 2013 (UTC)

Not a big fan of the big lists of authors. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:02, 7 November 2013 (UTC)

Okay. I'll run it, but remove the list of authors. There are so many other issues here!Fconaway (talk) 03:41, 8 November 2013 (UTC)

How many authors are acceptable? Or, do you want to select certain authors' names for deletion?Fconaway (talk) 04:47, 8 November 2013 (UTC)

Fatigue revert?

Who keeps reverting my edit?

The Forton article I'm referring to is is in Hepatology. It is the most reputable journal about viral hepatitis....so I am not sure I understand the repeated revert at all.

One reason it is important to correct this is that it is not true that the illness is always asymptomatic in the early stages. A high proportion of hep C patients first identify that they have a viral illness because of the characteristic fatigue/flu-like symptoms.

Some organizations (ALF and others) make a point in the public interest of letting people know about this so they can get tested if they have been a previous intravenous drug user or had blood transfusions.

There are not *as many* peer-reviewed articles about the possible cause of the fatigue/cognitive impairment as there should be. The arcticles show that the fatigue does not correlate with ALT, fibrosis, ammonia, or any other biochemical marker but does remit if a patient clears the virus in treatment.

The Forton et al article identifies changes in the brain with an MRI, and does cognitive testing.

Since the edit has been reverted twice, some administrator please see what is happenning here?

The article is D. Forton et al, Hepatitis C and Cognitive Impairment... Hepatology 25 pp 638 - 642. Createangelos (talk) 02:18, 4 December 2013 (UTC)

It was a primary source. Please use review articles. There is a difference. Wikipedia has pages on these topics. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:22, 4 December 2013 (UTC)

OK I get it now, thanks for fixing this. Createangelos (talk) 02:25, 4 December 2013 (UTC)

New Treatment Sofosbuvir: Edit request

In the article it states that "This benefit is somewhat offset by a greater rate of adverse effects" referring to the new treatment in comparison to interferon treatment. However I have found several sources directly contradicting this: http://www.news-medical.net/news/20130425/Sofosbuvir-is-safer-than-interferon-for-hepatitis-C-patients-say-scientists.aspx "Sofosbuvir is much safer drug than interferon, which many patients do not respond to or tolerate" and http://www.ncbi.nlm.nih.gov/pubmed/24289735 " So far, no safety signal in preclinical/clinical studies has been observed with this compound"

In addition to this the review article submitted for evidence of this claim is specifically to do with Therapy for Hepatitis C Virus–Related Cryoglobulinemic Vasculitis which only occurs in a quarter of Hep C patients. In light of this I think this claim should be removed — Preceding unsigned comment added by Rpzrz (talk • contribs) 03:05, 31 December 2013 (UTC)

This ref raises the concerns [5] Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:12, 31 December 2013 (UTC)

NEJM 2014 -- Daclatasvir plus Sofosbuvir, ± RBV

2 articles in the NEJM.

http://www.nejm.org/doi/full/10.1056/NEJMoa1306218 Daclatasvir plus Sofosbuvir for Previously Treated or Untreated Chronic HCV Infection N Engl J Med 2014; 370:211-221 January 16, 2014 DOI: 10.1056/NEJMoa1306218 nejmoa1306218.pdf

http://www.nejm.org/doi/full/10.1056/NEJMoa1306227 Phase 2b Trial of Interferon-free Therapy for Hepatitis C Virus Genotype 1 N Engl J Med 2014; 370:222-232 January 16, 2014 DOI: 10.1056/NEJMoa1306227 nejmoa1306227.pdf

They talk about sustained virologic response of 90-100%, although I haven't examined the confidence intervals yet. Should we update the numbers in the entry?

I think I've seen people refer to SVR as a cure. How well-accepted is that? How long have people gone with SVR without relapse now?

BTW, here's my PubMed search:

http://www.ncbi.nlm.nih.gov/pubmed?term=("2013"[PDAT] : "3000"[PDAT]) AND (("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("hepatitis c"[MeSH Terms] AND (((((("The New England journal of medicine"[Journal] OR "JAMA : the journal of the American Medical Association"[Journal]) OR "JAMA internal medicine"[Journal]) OR "Lancet"[Journal]) OR "BMJ (Clinical research ed.)"[Journal]) OR "Annals of internal medicine"[Journal]) OR "medicine"[Journal])))&dispmax=50 Hepatitis C

And here's the same search with the abstracts:

http://www.ncbi.nlm.nih.gov/pubmed?term=("2013"[PDAT] : "3000"[PDAT]) AND (("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("hepatitis c"[MeSH Terms] AND (((((("The New England journal of medicine"[Journal] OR "JAMA : the journal of the American Medical Association"[Journal]) OR "JAMA internal medicine"[Journal]) OR "Lancet"[Journal]) OR "BMJ (Clinical research ed.)"[Journal]) OR "Annals of internal medicine"[Journal]) OR "medicine"[Journal])))&dispmax=50&report=abstract

--Nbauman (talk) 06:48, 18 January 2014 (UTC)

No we should wait for newer secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:47, 18 January 2014 (UTC)

NOW@NEJM

Jmh649,

NOW@NEJM is a "blog" that is an official publication of the NEJM. It's written by a doctor who is a professor at Harvard Medical School. It's under the ageis of NEJM, and certainly the editors of the NEJM review it. It consists of excerpts, usually direct quotes, from articles from the NEJM. It's more reliable than some peer-reviewed journals.

The main benefit of NOW@NEJM is free access, unlike the underlying article. Most people don't subscribe to the NEJM and can't get access to it. Furthermore, it's a good summary.

According to WP:MEDRS, https://en.wikipedia.org/wiki/Wikipedia:Reliable_sources_%28medicine-related_articles%29#Other_sources

Press releases, blogs, newsletters, advocacy and self-help publications, and other sources contain a wide range of biomedical information ranging from factual to fraudulent, with a high percentage being of low quality.... Consequently, they are usually poor sources and should always be used with caution, never used to support surprising claims, and carefully identified in the text as preliminary work. Peer reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources in themselves, [Emphasis added]

Therefore, blogs -- if it is a blog -- can be used "with caution." It's certainly as reliable as Mayo Clinic.

According to WP:RS WP:UGC

"Blogs" in this context refers to personal and group blogs. Some news outlets host interactive columns they call blogs, and these may be acceptable as sources so long as the writers are professional journalists or are professionals in the field on which they write and the blog is subject to the news outlet's full editorial control. [Emphasis added]

This is clearly a blog in which writers are professionals in the field in which they write and the blog is subject to the news outlet's full editorial control.

Why do you delete links to NOW@NEJM? --Nbauman (talk) 05:06, 19 January 2014 (UTC)

I think it might be a better idea to include the link to the blog post in the NEJM reference, rather than giving the impression that this is a completely distinct source. It doesn't look like it is peer reviewed. JFW | T@lk 07:02, 19 January 2014 (UTC)

We have the actual source. We do not add lesser sources just because they are free. We already have the abstract. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:58, 19 January 2014 (UTC)

What abstract? There is no abstract. --Nbauman (talk) 21:34, 20 January 2014 (UTC)

Right here [6] Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:33, 21 January 2014 (UTC)

Jmh, when you say, "We do not use blogs," who is "We"? --Nbauman (talk) 07:18, 26 January 2014 (UTC)

We do not use blogs for medical content per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:04, 26 January 2014 (UTC)

As I quoted above, WP:MEDRS says that we can use blogs "with caution." WP:UGC says that blogs are "acceptable" if the writers are professionals in the field on which they write and the blog is subject to the news outlet's full editorial control.

Is that correct? --Nbauman (talk) 03:55, 29 January 2014 (UTC)

There is no need to include this blog. We have the full paper and it is free. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:55, 29 January 2014 (UTC)

In this case, the full paper is free, but in most cases it is not. This issue has come up before and it will come up again.

WP:MEDRS says that we can use blogs "with caution." WP:UGC says that blogs are "acceptable" if the writers are professionals in the field on which they write and the blog is subject to the news outlet's full editorial control.

Is that correct? --Nbauman (talk) 04:21, 2 February 2014 (UTC)

Blogs are not typically very good sources. We should be using the best available sources. So for a GA or FA I would say a better source should be found for health care info and it should replace the blog. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:31, 2 February 2014 (UTC)

I'm asking you whether I am accurately quoting WP:MEDRS and WP:UGC. Yes or no? --Nbauman (talk) 12:11, 2 February 2014 (UTC)

No you are taking MEDRS out of context. For medical content we do not use blogs. They can be used for other stuff.Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:17, 2 February 2014 (UTC)

Where does WP:MEDRS have an absolute prohibition against blogs? Doesn't it say that we can use blogs "with caution"? --Nbauman (talk) 21:22, 2 February 2014 (UTC)

The tone of MEDRS, as reflected in Doc James' comments here, is clear - we apply the highest possible sourcing standards to health-related content; therefore, we don't use blogs when the content is covered in more reliable sources. -- Scray (talk) 23:49, 2 February 2014 (UTC)

WP:MEDRS says that we can use blogs "with caution." Is that correct or not? -- Nbauman (talk) 13:27, 3 February 2014 (UTC)

Nbauman, here is the problem: Blogs are more limited in authority and utility than independently-published peer-reviewed secondary sources. Blogs, when they are used, are never more useful than for sourcing the view of the blogger cited. Blogs generally are not peer-reviewed, and they are essentially self-published, in that the blogger--in conjunction with the blogger's organization--can choose to publish whatever they like without the need to pass it by an independent editorial board that determines the significance. They fall under the category of "expert opinion". This is why per WP:MEDASSESS they fall near the bottom of evidence quality. Additionally, in this case, adding the blog to the existing content fails WP:V because the existing content cited to PMID 20187106 doesn't have the qualifiers that would need to be added to use the blog ("Writing in the NEJM blog, Sara Fazi states that...") and then there'd also be the question of demonstrating that this blog meets WP:DUEWEIGHT. The systematic review does not have any of these problems. That's why we need to use the systematic review and not the blog. Zad68 14:55, 3 February 2014 (UTC)

It is a not a black and white answer. It depends what information you are trying to support and what other sources are available. That is what "with caution means". In this situation you cannot use blogs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:51, 3 February 2014 (UTC)

Let me get this peer-review objection out of the way. It's an editorial summary of a peer-reviewed article, so all the medical issues are peer-reviewed already. There's nothing in there that hasn't been reviewed by the NEJM's peer-reviewers. So it is peer-reviewed. Can we agree with that? --Nbauman (talk) 16:14, 3 February 2014 (UTC)

Ah not that case. Blogs are not generally peer reviewed. They are an interpretation of a peer reviewed source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:19, 3 February 2014 (UTC)

Doc is correct, and this is really the whole point: The blogger's interpretation of the source hasn't been shown to be independently peer-reviewed and published; the underlying source is what we know is independently peer-reviewed and published. I hope we can agree that an independently peer-reviewed and published source is of a higher caliber/more desirable than one that is not, and so the issue is resolved by simply using the independently peer-reviewed and published source instead of the blog, and we're done. Zad68 16:30, 3 February 2014 (UTC)

I've worked on peer-reviewed journals. They send the manuscript out to peer reviewers. They get the manuscript back, and put it through the editorial process. They make editorial changes. They query authors and make revisions. Now they often post an online-first version to the Internet, and make final changes in the printed version. None of those editorial changes are peer-reviewed.

So by your logic, we shouldn't accept the published, edited version of the article as a WP:RS. We should only accept the original manuscripts that they get back from the peer reviewers, because nothing after that is peer reviewed. Is that correct? --Nbauman (talk) 05:44, 4 February 2014 (UTC)

Peer review is not the only requirement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:04, 4 February 2014 (UTC)

Nbauman I feel like your responses have moved out of the realm of good-faith suggestions to improve this article and into point-making, and I don't feel like following you in that direction. At this time there is not consensus to include the blog. Zad68 14:14, 4 February 2014 (UTC)

I am assuming your good faith that you sincerely believe in these pedantic objections. I'm trying to make medical knowlege more accessible to people who don't have access to peer-reviewed journals.

You have objections which I still don't understand. I remember the days when patients were supposed to let doctors make their decisions for them, and not to challenge their doctor's authority by reading journals.

You still haven't given me a valid reason based on Wikipedia guidelines for excluding NOW@NEJM as a WP:MEDRS.

Nothing that you say about blogs applies to NOW@NEJM. It's not a "blog" as you use the term, as a personal or unreviewed commentary. It's not a "blog" as WP:UGC uses the term, which is "personal and group blogs."

NOW@NEJM is not self-published; it's published by the NEJM under their name, and it's reviewed by other editors every week. Sara Fazio can't publish "whatever she likes." She can only summarize and analyze the article that has already been peer-reviewed. The blog meets WP:DUEWEIGHT because Fazio is a professor at Harvard, on the staff of the NEJM, and one of her areas of professional work is medical education http://ecommons.med.harvard.edu/ec_vqp.asp?Name_GUID={4C66906E-B77C-4C94-8B45-EEB9EBEEDF04} I think she has a better understanding of what should be given due weight in a NEJM review article than we do.

Besides, I've just reread WP:RSMED carefully, and they discuss peer-reviewed journals; WP:RSMED doesn't say that every article in a peer-reviewed journal must itself be peer-reviewed. Nothing in WP:RSMED forbids the use for example of a solicited commentary which is not peer-reviewed. So all the editorial content of the NEJM meets WP:RS, just because the NEJM is a peer-reviewed journal (and widely recognized to boot).

This particular article is moot because the entire article is open access, but for the future, I think anyone who reviews your arguments and mine will agree with me that you can't support your objections with the text of WP guidelines. --Nbauman (talk) 19:11, 4 February 2014 (UTC)

Agree with DocJames and Zad68; the existing review is the only necessary source; the NOW@NEJM is certainly a lower quality source and is unnecessary. Insisting on keeping it in seems WP:POINTy. Yobol (talk) 19:14, 4 February 2014 (UTC)

Screening, serology

I am aware that my entry under screening is a repeat of what is already concisely written in the serology section. Nevertheless, people who are testing positive with the commercial EIA kits are not necessarily infected. This is also why the EIA kits are not suitable for diagnosing hep. C nor for determining the hep. C status of a certain population. This study, albeit a bit old already, quantifies the false positive results, and is consistent with what was already mentioned in the serology section. (Osterluzei (talk) 12:07, 8 February 2014 (UTC))

It is a 15 year old primary study. You need to find a recent review article or a similarly high quality source per our guideline on medical sourcing before such material can go into this article. Yobol (talk) 16:58, 8 February 2014 (UTC)

Potential origin of Hepatitis C from bats

There is a study published in Proceedings of the National Academy of Sciences (http://www.pnas.org/content/110/20/8194) pointing to the Hepatitis C virus originating in bats. Should this be mentioned here? Muju (talk) 16:30, 25 February 2014 (UTC)

Need secondary source Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:15, 25 February 2014 (UTC)

Semi-protected edit request on 2 April 2014

Under the heading "Animal Models", the word "is" should be removed in the statement "Currently, chimpanzees remain the available living system to study, yet their use is has ethical concerns and regulatory restrictions." Abnerkadabra (talk) 21:38, 2 April 2014 (UTC)

Not done: please provide reliable sources that support the change you want to be made. — {{U|Technical 13}} ^{(t • e • c)} 23:04, 2 April 2014 (UTC)

Corrected. Thanks Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:27, 3 April 2014 (UTC)

Semi-protected edit request on 10 April 2014

• WHO Issues First Guidelines for Hepatitis C Treatment

Sujoyhnkc (talk) 19:25, 10 April 2014 (UTC)

Okay and? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:50, 10 April 2014 (UTC)

 Not done - It is unclear what changes you wish to bring about in the article. Submit your request in this form, "change X to Y". Anupmehra -Let's talk! 19:52, 10 April 2014 (UTC)

I will add it to the further reading section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:53, 10 April 2014 (UTC)

Semi-protected edit request on 14 April 2014

This article on Hepatitis C is in need of revision. There is currently a vaccine 'Solvadi' that cures the disease. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm377888.htm

2602:304:AEB0:AB50:30DE:3423:D80E:14B5 (talk) 15:22, 14 April 2014 (UTC)

Not done: it's not clear what changes you want made. Please mention the specific changes in a "change X to Y" format. Jackmcbarn (talk) 18:27, 14 April 2014 (UTC)

'Solvadi' is not a vaccine. It is just the trade name for sofosbuvir. Ruslik_Zero 19:34, 14 April 2014 (UTC)

Yes agree with Rus Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:19, 16 April 2014 (UTC)

abt

http://www.easygoodhealth.com/get-healthy/cure-rate-for-experimental-hepatitis-c-drug-tops-95-percent why is it not mentioned? Why is the article written as if it is 2010 and with epidemiology data fro 15 years ago. Needs updating like many wikipedia articles to present day knowledge. I guess wikipedia needs a clock on articles that purport to be current but use historical data to say when they should update. I'd say thr time it takes to do a PhD is reasonable. — Preceding unsigned comment added by 223.206.13.215 (talk) 05:50, 16 April 2014 (UTC)

Semi-protected edit request on 21 May 2014

I am a board certified hepatologist. I did not read entire article only the copy/paste portion below which is quite inaccurate. Please see my changes in bold:

Medications

In general, treatment is recommended for those with proven HCV infection and signs of liver inflammation.[9] As of 2010, treatments consist of a combination of pegylated interferon alpha and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on HCV genotype.[9] This produces cure rates of between 70 and 80% for genotype 2 and 3, respectively, and 45 to 70% for other genotypes.[72] There is no firm evidence that any brand of pegylated interferon is superior to any other

Combining either boceprevir or telaprevir with ribavirin and peginterferon alfa improves antiviral response for hepatitis C genotype 1.[74][75][76] Adverse effects with treatment are common, with half of people getting flu like symptoms and a third experiencing emotional problems.[9] Treatment during the first six months is more effective than once hepatitis C has become chronic.[22] If someone develops a new infection and it has not cleared after eight to twelve weeks, 24 weeks of pegylated interferon is recommended.[22] In people with thalassemia, ribavirin appears to be useful but increases the need for transfusions.[77]

Sofosbuvir with ribavirin and interferon appears to be around 90% effective in those previously untreated with genotype 1, 4, 5, or 6 disease.[78] Sofosbuvir with just ribavirin appears to be 70 to 95% effective in genotypes 2 and 3 but these genotypes are not very common.[72][78] Therapy without interferon is more easily tolerated. Treatments that contain ledipasvir and sofosbuvir for genotype 1 has success rates of around 93 to 99%and are expected to be approved by the FDA in October of 2014. The cost is not yet known In genotype 6 infection, pegylated interferon and ribavirin is effective in 60 to 90% of cases.[80] There is some tentative data for simeprevir use in type 6 disease as well.[80] Because the field is changing so rapidly, the new treatment guidelines will be frequently updated and can be found at www.hcvguidelines.org

Surgery

Cirrhosis due to hepatitis C is a common reason for liver transplantion[22] and the virus recurs in all cases Infection of the graft leads to 10–30% of people developing cirrhosis within five years.[82] Treatment with pegylated interferon and ribavirin post transplant decreases the risk of progression and a number of trials are currently being conducted on the newer therapies that do not contain interferon Dfdies (talk) 19:14, 21 May 2014 (UTC) Dfdies (talk) 19:14, 21 May 2014 (UTC)

Not done: please provide reliable sources that support the change you want to be made. Thanks for wanting to improve the article, but we cannot use unverifiable personal knowledge to modify the content of the article. Regards, Older and ... well older (talk) 19:48, 21 May 2014 (UTC)

This article should be updated to include the new drug *Sovaldi* Which has a 90% cure rate for Hepatitis C. 98.202.136.243 (talk) 05:30, 1 August 2014 (UTC)douglockman@gmail.com

Mentioned 3 times. Generic name is Sofosbuvir Doc James (talk · contribs · email) 20:36, 11 January 2015 (UTC)

Harvoni

I added info on the new drug Harvoni and it's gone? Without it this article is painfully out of date. http://www.harvoni.com/ Michelle Ress.

Ledipasvir is already mentioned in this article. Ruslik_Zero 03:28, 15 December 2014 (UTC)

Also read WP:MEDRS. The ref you used is a little spammy. Best Doc James (talk · contribs · email) 03:32, 17 December 2014 (UTC)

Lancet Seminar 2015

This should solve the problem of being outdated.
Webster DP, Klenerman P, Dusheiko GM
Seminar: Hepatitis C
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62401-6/abstract
The Lancet.
Online February 13, 2015.
doi: 10.1016/S0140-6736(14)62401-6
--Nbauman (talk) 04:41, 16 February 2015 (UTC)

Treatment

Very good article but could use an update on treatment. As of 7 or 8 months ago, the best available treatment is Harvoni. No more interferon or ribavirin. SVR rates are a little higher with this new drug, also. — Preceding unsigned comment added by 98.194.6.84 (talk) 05:22, 10 August 2015 (UTC)

Yes we have this paper here [7] which speaks about its use for genotype 1 infections. Does not say it is the "best" though. Will look at adding something. It is ledipasvir/sofosbuvir Doc James (talk · contribs · email) 15:16, 10 August 2015 (UTC)

We already discuss it actually "Treatments that contain ledipasvir and sofosbuvir for genotype 1 has success rates of around 93 to 99% but is very expensive" Doc James (talk · contribs · email) 15:18, 10 August 2015 (UTC)

Semi-protected edit request on Oct 8, 2015

Suggest to change the Treatment section to the text below, as it is horribly out of date. Also, the Prognosis section should be deleted, as it refers entirely to the results of a treatment modality that has not been used in over 5 years.

Prior to 2011, the standard treatment for hepatitis C infection involved 24-48 weeks administration of peginterferon and ribavirin. Due to the severe side effects of peginterferon, including flu-like symptoms, nausea, depression, anemia, and low white blood cell counts, treatment was typically restricted to those with relatively advanced liver disease. Cure (SVR) rates using this regimen are about 50% for genotype 1 and 80% for genotypes 2 and 3.

In 2011, the US FDA approved the HCV protease inhibitors telaprevir and boceprevir for the treatment of hepatitis C genotype 1. Used in combination with peginterferon/ribavirin, these new drugs provided a somewhat higher cure rate (60% to 70%) and allowed a reduction in the duration of treatment for some people. The side effects of triple therapy are increased, however, relative to peginterferon-ribavirin alone. In the wake of approval of newer drugs that provide high cure rates without the use of peginterferon, telaprevir was withdrawn from the market in the U.S.

In late 2013, the first interferon-free treatment regimen, consisting of 12-24 weeks treatment with ribavirin and the nucleoside analog sofosbuvir, was introduced. The treatment regimen provides moderate-to-high SVR rates in people with genotype 2 or genotype 3 HCV. Combinations of sofosbuvir with other drugs, such as the viral NS5a inhibitor ledapsvir or daclatasvir, provides high SVR rates in genotype 1. . Other combinations, such as that of a second generation HCV protease inhibitor with an NS5A inhibitor with ribavirin and/or a non-nucleoside HCV polymerase inhibitor are effective in genotype 1 as well. In general, these newer regimens provide SVR rates of about 90% with 8-24 weeks treatment and are significantly better tolerated than interfereon-containing regimens. The cost of these newer treatments has generated considerable controversy.

The American Association for the Study of Liver Diseases has issued detailed treatment guidelines that take into account various patient characteristics, including the genotype of the virus, prior treatment history, and the presence or absence of liver cirrhosis.

2601:643:8100:8AF4:1123:B66F:39D2:84E0 (talk) 12:12, 7 October 2015 (UTC)

I have updated with the 2015 IDSA guideline. Let me know what you think. Doc James (talk · contribs · email) 13:15, 11 October 2015 (UTC)

That looks really good, thank you. The only minor additional comments I would have would be that per my understanding, neutropenia, thrombocytopenia, and anemia were the most important adverse events of the interferon-based regimen and that the prognosis section still refers to the interferon regimen. 2601:643:8100:8AF4:163:9E9B:3AC6:210B (talk) 03:58, 12 October 2015 (UTC)

Agree and adjusted prognosis. WRT neutropenia, in which section do you see concern? Thanks Doc James (talk · contribs · email) 22:39, 12 October 2015 (UTC)

Minor point only: You have "Adverse effects with these treatments were common, with half of people getting flu like symptoms and a third experiencing emotional problems". but per the Pegasys package insert, "Overall 39% of subjects with CHC or CHC/HIV required modification of PEGASYS and/or COPEGUS therapy. The most common reasons for dose modification of PEGASYS in CHC and CHC/HIV subjects was for neutropenia (20% and 27%, respectively) and thrombocytopenia (4% and 6%, respectively). The most common reason for dose modification of COPEGUS in CHC and CHC/HIV subjects was anemia (22% and 16%, respectively)." So the bone marrow suppression struck me as the bigger issue. 2601:643:8100:8AF4:F8D7:EED4:5BF8:D887 (talk) 03:21, 13 October 2015 (UTC)

References

Cure rates

Regarding User:Doc James recent edit;

The figures and sources provided look like they come out of Southeast Asia. That's fine, but I think it's worth making the point that in the first world, cure rates are approaching 100% (ref) with more recently developed drugs. I think the 60-90% figure may be vaguely misleading or overly ambiguous. I'm going to try to tweak the language a bit to come up with something a little more informative. NickCT (talk) 13:38, 30 October 2015 (UTC)

I agree that the genotype 6 (southeast Asian) study is not geographically or virologically representative (genotype 6 is uncommon in the rest of the world). That said, the literature for success rates of current HCV therapy is almost entirely from carefully-monitored clinical trials, which tend to paint an unrealistically rosy picture (when real-world studies ensue). While not MEDRS-compliant (and thus not proposed for citation in the article), this recent summary from EASL illustrates the broad range of SVR (cure) rates observed in ongoing "real world" observational studies. It's unfortunate that we don't have a compelling MEDRS for this - I will try to find one - but the range Doc James entered is reasonably accurate (with respect to consensus of the scientific community). In part, the range relates to continued variable outcomes in some populations. — soupvector (talk) 15:44, 30 October 2015 (UTC)

@Soupvector: - Agree with your analysis. If you do find some good data, let us know. I wouldn't be surprised if data like this didn't exist.

If you look at what the WHO says about global cure rates, there answer seems to be a slightly vague "it depends"(ref). NickCT (talk) 16:41, 30 October 2015 (UTC)

Yes a lot depends on the HCV type. Thus we are going to end up with a wide range. Doc James (talk · contribs · email) 17:58, 30 October 2015 (UTC)

The CDC from 2015 says 80 to 95% with the newer medication [8]

The newer meds are not avaliable in much of the world. Thus the entire range for both should be stated. We can than state the newer ones work better. Doc James (talk · contribs · email) 07:58, 31 October 2015 (UTC)

The CDC in an Oct 14, 2015 document states "Clinical trials have shown that these new medications achieve SVR in 80%-95% of patients after 12-24 weeks of treatment."[9]

This in my opinion is better than an older July 28, 2014 document from the FDA directed towards consumers that states "Today’s pills have double the viral cure rates—90% to 100%—in just in 12 weeks’ time."[10]

Others thoughts? Doc James (talk · contribs · email) 19:42, 2 November 2015 (UTC)

@Doc James: - Your problem with the FDA source is that it was published earlier, and is hence, less reliable? I don't think the CDC and FDA sources conflict. If you read it carefully, the CDC says efficacy of both Olysio and Sovaldi is somewhere between 80 to 95%. In other words, I think the CDC is summarizing multiple clinical and giving a wide range to incorporate those multiple studies.

I think the FDA source is reviewing a single clinical trial (probably some regiment including Sovaldi), and hitting numbers >90%. My understanding from having previously read up on this subject, is that the most promising clinical trials were hitting numbers >90% regardless of subtype. It might be a good idea if I find a source for that though. NickCT (talk) 20:10, 3 November 2015 (UTC)

The FDA often just repeats primary sources will the CDC more often does reviews. Reviews are better in giving an overall picture. Doc James (talk · contribs · email) 00:28, 4 November 2015 (UTC)

Semi-protected edit request on 13 January 2016

Please ad the sentence: Sharing drug-sniffing implements is a possible cause of intranasal transmission of hepatitis C virus and infection. in the section "Shared personal items", after the word "HCV" and before the word "Appropriate". Thank you!

24.34.73.59 (talk) 01:24, 13 January 2016 (UTC)

Is their a better secondary source that touches on this? This other primary source says no risk [11] Doc James (talk · contribs · email) 02:45, 13 January 2016 (UTC)

Okay found a ref [12] Doc James (talk · contribs · email) 02:48, 13 January 2016 (UTC)

Thank you for taking partial action on this request. However, since intranasal drug use per se is not a likely mode of viral transmission unless something contaminated is typically shared in the process (see references), it would be useful to say at least: "Intranasal drug use may also be a risk factor, for example by sharing the inhalation implements." Someone reading this article as it is, would not necessarily get the nuances implied by the current general statement about drug use. People can benefit the most by associating the "sharing" with the risk, since that is the most relevant reason of intranasal transmission, and supported by the references. So I request that the "sharing" be added in the context of intranasal drug use. Thank you. Here is a better source, as you requested [13] 24.34.73.59 (talk) 08:47, 22 June 2016 (UTC)

References

Re-open if there are issues. — Andy W. (talk · ctb) 22:54, 4 July 2016 (UTC)

Semi-protected edit request on 23 February 2016

On the 3rd paragraph on the page for Hepatitis C ref https://en.wikipedia.org/wiki/Hepatitis_C there is a small pronouncing error of the 1st word of the second sentence. i beleive this should be prevention and not the word prevent or it should be rephrased to say there is no way to prevent im sure i dont need to provide refrences on grammer but if required i can Sclitt (talk) 14:11, 23 February 2016 (UTC) Sclitt (talk) 14:11, 23 February 2016 (UTC)

 Done Thanks for pointing that out - Arjayay (talk) 14:44, 23 February 2016 (UTC)

Semi-protected edit request on 12 May 2016

To take out Par."Drug Use", sentence 2: Of 77 countries reviewed 25 (including U.S.) were found to have prevalence of Hepatitis C in IV drug user population of between 60% and 80%. and remove the graph. Please change to: Hepatitis C is a leading cause of liver cancer and the leading cause of liver transplants; People born between 1945-1965 account for 73% of all Hepatitis C mortality.Trotter12 (talk) 04:39, 12 May 2016 (UTC) Thank you. Trotter12 (talk) 04:39, 12 May 2016 (UTC)

Not done: please provide reliable sources that support the change you want to be made. And why remove that sentence? Cannolis (talk) 13:12, 12 May 2016 (UTC)

Vertical transmission

Can we rename this section "From mother". Vertical transmission is obscure medical jargon. 69.86.6.150 (talk) 00:05, 14 May 2016 (UTC)

"Vertical transmission" is a very specific term for a particular well defined route of transmission. "From mother" is vague - would a blood transfusion from the mother to a child count? Ruslik_Zero 01:54, 14 May 2016 (UTC)

Vertical transmission is vague. It could be talking about anything. The section header should give some hint as to the topic of the section. Jargon isn't appropriate. How about "Pregnancy and childbirth"? 69.86.6.150 (talk) 04:32, 14 May 2016 (UTC)

"Mother-to-child transmission" (abbreviated MTCT) is a commonly-used, easily-understood term that is used interchangeably with "vertical transmission". — soupvector (talk) 14:51, 14 May 2016 (UTC)

Excellent suggestion. Changed to mother to child transmission. Doc James (talk · contribs · email) 15:51, 14 May 2016 (UTC)

 Done : Thanks 69.86.6.150 (talk) 20:19, 14 May 2016 (UTC)

Hepatitis C Core Antigen Testing for Diagnosis

doi:10.7326/M16-0065 JFW | T@lk 10:01, 22 June 2016 (UTC)

HIV & HCV co-infection

Systematic review doi:10.1016/S1473-3099(15)00485-5 JFW | T@lk 10:03, 22 June 2016 (UTC)

Acute HCV death rate data?

Acute hepatitis C deaths per million persons in 2012

  0-0

  1-1

  2-2

  3-3

  4-7

  8-51

I don't see a reference in the caption created in this edit, so I'm just curious about where the data came from. I would think that this and other figures should have a data source cited in the caption. — soupvector (talk) 16:02, 8 August 2016 (UTC)

Sorry about that - I just realized the citation is in the details for the figure itself, here, and that points to the WHO's GHE data set. It's true that those rates are for "Acute Hepatitis C" in the spreadsheet, but that seems wrong. For example, the stated rate for the USA is 8.9 deaths from acute HCV per million persons, and 8.9 * 317.5 (millions of people in USA, according to the WHO GHE table) = 2 826 deaths due to acute HCV in 2012. The CDC reports that in 2012 there were 1 778 reported (and 24 700 estimated) new HCV infections in the USA. I am confident that the death rate from new HCV infection is far lower than 10%. Unless I'm missing something, the WHO's GHE data for acute HCV death rates seem unbelievable, and I think the graph should be removed from this article. — soupvector (talk) 16:19, 8 August 2016 (UTC)

Thanks yes strange. So the table is saying 8,900 deaths from acute hepatitis C for a population of 317.5M.

The CDC gives a range of acute cases of 19.6K to 84.4K. So agree seems a little high.

I imagine WHO is taking data submitted by the CDC so wonder why the discrepancy unless they are mixing some chronic case deaths in there. Doc James (talk · contribs · email) 16:41, 8 August 2016 (UTC)

It says there is a total of 38,914 total deaths from acute hep C globally. Doc James (talk · contribs · email) 16:46, 8 August 2016 (UTC)

These data can not be right - the death rate in USA can not be higher then Africa where Hep C is endemic. Ruslik_Zero 17:23, 8 August 2016 (UTC)

Agree. WHO must have made an error somewhere in there. Doc James (talk · contribs · email) 01:39, 9 August 2016 (UTC)

Testing in the current treatment paradigm

doi:10.1128/CMR.00037-16 JFW | T@lk 23:37, 21 December 2016 (UTC)

Potentially useful resource

Just published by the National Academy of Medicine and free online: National Strategy for the Elimination of Hepatitis B and C. -- — soupvector (talk) 06:08, 29 March 2017 (UTC)

Canine hepacivirus (CHV)

There's evidences that dogs can be infected by CHV, but no mention of this appears on the page. — Preceding unsigned comment added by Tkadm30 (talk • contribs) 13:26, 25 April 2017 (UTC)

Semi-protected edit request on 28 June 2017

Treatment should be replaced from Medications to Antivirals as it would show the exact group of medications used to treat Hepatitis C 198.52.13.15 (talk) 10:10, 28 June 2017 (UTC)

I think medication is fine. Doc James (talk · contribs · email) 16:26, 28 June 2017 (UTC)

Request for new addition to the Treatment section

Please add the paragraph below right under the last line of the treatments list, that says: "HCV genotype 5 or 6: sofosbuvir and ledipasvir":

"The US Food and Drug Administration (FDA) approved Vosevi (Gilead Sciences), a pan-genotypic medication, to treat adults with chronic HCV genotypes 1 through 6 without cirrhosis or with mild cirrhosis, who have been previously treated with the direct-acting antiviral drug sofosbuvir or other drugs for HCV that inhibit NS5A but, whose treatment has failed. Vosevi is a once-daily single tablet to be taken for 12 weeks that contains the nucleotide analog nonstructural protein NS5B polymerase inhibitor sofosbuvir (400 mg) and the HCV NS5A inhibitor velpatasvir (100 mg), and the pan-genotypic HCV NS3/4A protease inhibitor voxilaprevir (100 mg)."

I included the reference in the source but, it does not show here unless you look at the source.

Thank you 73.119.19.79 (talk) 01:19, 27 July 2017 (UTC)

References

Done Stickee (talk) 02:12, 27 July 2017 (UTC)

Adjusted some. Doc James (talk · contribs · email) 02:31, 27 July 2017 (UTC)

Good enough. Thank you. 73.119.19.79 (talk) 15:28, 27 July 2017 (UTC)

The list of medications for different genotypes is obsolete though, and needs to be updated 73.119.19.79 (talk) 15:28, 27 July 2017 (UTC)

That was the 2015 IDSA guideline. Have they come out with a new one? Doc James (talk · contribs · email) 21:03, 27 July 2017 (UTC)

Yep: http://hcvguidelines.org/sites/default/files/full-guidance-pdf/HCVGuidance_April_12_2017_b.pdf 73.119.19.79 (talk) 14:47, 28 July 2017 (UTC)

To save time, I recommend the contents from page 48 to 127 of the PDF document. Thank you if you take care of this. 73.119.19.79 (talk) 14:59, 28 July 2017 (UTC)

Perfect, thank you :-)

Page numbers in the document suck. Doc James (talk · contribs · email) 19:15, 28 July 2017 (UTC)

Update to the 2017 doc. Doc James (talk · contribs · email) 20:34, 28 July 2017 (UTC)

Could explicitly mention direct-acting antivirals since DAA links here for it. (and the article already uses ref name=Mücke2018 which mentions them in the title) - Rod57 (talk) 01:46, 7 March 2018 (UTC)