August 16, 2010

Fittest hepatitis C viruses infect transplanted livers

Public release date: 16-Aug-2010

Contact: Rita Sullivan
news@rockefeller.edu
212-327-8603
Rockefeller University Press

Not all viruses are created equal. In liver transplant patients with chronic hepatitis C virus (HCV) infection, only viruses that can dodge the immune response invade the new liver, according to a study published on August 16 in The Journal of Experimental Medicine (http://www.jem.org/).

Chronic HCV infection is the leading indication for liver transplantation in the US. But installing a new liver does not cure disease; in fact, HCV infects the transplanted liver in nearly all patients. However, only a subset of the viruses present prior to transplantation show up in the new organ, according to a study lead by Francoise Stoll-Keller and Thomas Baumert at the University of Strasbourg in France. Compared to many of their pre-transplant brethren, the viruses that invaded the new organ infected liver cells more readily and were impervious to the antibodies that normally block infection.

In most patients, the post-transplant viruses had mutations in one region of the surface protein the virus uses to infect cells. Blocking this region may thus provide a new way to prevent reinfection after liver transplant.

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About The Journal of Experimental Medicine

The Journal of Experimental Medicine (JEM) is published by The Rockefeller University Press. All editorial decisions on manuscripts submitted are made by active scientists in conjunction with our in-house scientific editors. JEM content is posted to PubMed Central, where it is available to the public for free six months after publication. Authors retain copyright of their published works and third parties may reuse the content for non-commercial purposes under a creative commons license. For more information, please visit http://www.jem.org/.

Fafi-Kremer, S., et al. 2010. J. Exp. Med. doi:10.1084/jem.20090766.

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Donor Risk Index does not impact outcomes on a small scale

August 16, 2010

The Donor Risk Index, which assesses donor characteristics impacting liver transplantation outcomes, does not bear the same impact on outcomes on a small scale as is suggested from large-scale, national data.

Rather, hepatitis C was shown to continue to be the major contributor to poor graft survival in transplant patients, according to a Henry Ford Hospital.

The goals of the study were to confirm the effect of the Donor Risk Index on liver transplant recipients and to evaluate further donor and recipient characteristics on transplant outcomes.

"We found the risks to be small for individual characteristics influencing outcomes except for hepatitis C," says Marwan Abouljoud, M.D., director of Henry Ford Hospital's Transplant Institute and lead author of the study.

"Looking at data from large studies is like looking under a microscope and when the information from many of these national studies is translated to day-to-day practice, the information often doesn't prove to be practical, especially when you consider patients are dying on transplant waiting lists."

Study results were presented today at the International Congress of The Transplantation Society in Vancouver.

The study looked at the DRI scores for 100 liver transplants between January and December 2008, analyzing recipients and their corresponding donors. Donor and recipient demographics, model for end-stage liver disease (MELD) scores, laboratory data, operative factors and pathologists were reviewed.

The presence of hepatitis in recipients post-transplant was found to have the biggest impact on mortality and graft failure. Death rate was 22 percent, of which 41 percent died due to recurrent hepatitis. The graft failure rate was 20 percent with hepatitis the cause in 44 percent of the cases.

The only Donor Risk Index subcategory that was associated with graft loss in the study was high donor age, says Dr. Abouljoud, who suggests that further study is needed to favorably impact graft survival within the context of the Donor Risk Index.

"Our findings suggest that the focus should be on the combined factors that effect organ quality and function, not one individual characteristic," says Dr. Abouljoud.

Currently, almost 16,000 people in the United States are waiting for liver transplants, according to the Health Resources and Services Administration. About 5,300 liver transplantations were performed in the United States in 2002.

Provided by Henry Ford Health System

Source
D. Yamini, B. Basseri, G. M. Chee, A. Arakelyan, P. Enayati, T. T. Tran, F. Poordad

Journal of Viral Hepatitis
Article first published online: 15 AUG 2010
DOI: 10.1111/j.1365-2893.2010.01361.x
© 2010 Blackwell Publishing Ltd

Author Information
Hepatology Section, Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

*Correspondence: Fred Poordad, MD, Chief, Hepatology and Liver Transplantation, Cedars-Sinai Medical Center, 8635 W. 3rd Street #1060-W, Los Angeles, CA 90048, USA. E-mail: Fred.Poordad@cshs.org
 
Keywords:depression;difficulty sleeping;fatigue;hepatitis C virus;quality of life;sexual dysfunction;smoking

Summary.  Hepatitis C virus (HCV) is known to adversely affect general, social, emotional and mental health domains. This study was designed to identify variables that may be associated with these measurable outcomes. We conducted a cross-sectional retrospective review of demographic and clinical data from 800 patients with HCV evaluated between January 1998 and November 2007. Data were collected using a standardized questionnaire filled out by the patients at the first encounter. Variables evaluated included fibrosis stages (i.e. FS0/1/2 vs FS3/4), demographics, comorbid health conditions, tobacco and alcohol use, high-risk social behaviours and laboratory data. Variables assessed were depression, fatigue, problems sleeping and loss of interest in sex. Statistical analysis was performed using univariate and multivariate logistic regression. Depression (29.3%) in our HCV study population was associated with female gender, tobacco use, hyperlipidemia, history of heavy alcohol use and intravenous drug use. Fatigue (44.6%) was associated with end-stage renal disease, past and current tobacco use and current alcohol use. Difficulty sleeping (13.8%) was associated with past and current tobacco use, current alcohol use and diabetes. Loss of interest in sex (7.7%) was associated with current tobacco use, multiple risk factors for HCV and age at time of evaluation. Fibrosis stage (FS) also had a significant positive association with alcohol use (OR 2.61; P = 0.003) and tobacco use (OR 2.00; P = 0.002). Smoking and alcohol use have a significant negative impact on the presence of depression, fatigue, difficulty sleeping and loss of interest in sex in HCV patients. Practitioners should be aware of these associations, particularly tobacco use, which significantly and negatively impacted every variable evaluated.

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Ohio man plans fundraiser for local Vietnam veteran

SUBMITTED PHOTO
Hart poses while stationed in the Vietnam War.

By Jill Whalen (Staff Writer)
Published: August 16, 2010
 
Rick Hart never met Frank Tate. And he probably never will, either.

The two live almost 540 miles from each other. Hart is in Monroe, Ohio; Tate lives in Drums.

Yet Hart, who served as a U.S. Marine during the Vietnam War just as Tate did, decided to hold a fundraiser to help Tate battle the liver disease that is claiming his life.

"I've been helping veterans for a long time," Hart said. But Tate's story really hit a nerve.

Hart learned of Tate's failing health from a Times-Shamrock newspapers article several days ago. Tate, 59, and a few of his doctors believe his cirrhosis is directly linked to his exposure to Agent Orange in Vietnam. The Department of Veterans Affairs, however, does not recognize the toxic chemical as a cause for cirrhosis. And doctors won't attempt a liver transplant, saying the procedure would be too risky since Tate's health is failing.

"I always think that like Frank, that could be me with the Agent Orange. When we were in Vietnam, they told us very little. The less we were told, I guess they thought the better. As a matter of fact, you didn't know what was going on," Hart said.

Like Tate, Hart saw maps of where Agent Orange was used to defoliate forests in Vietnam to expose the enemy.

"I had it dumped on me, too. That could be me. We might have eaten the same dirt," Hart said. "Who would do anything to help me if I was in Frank's situation? Probably nobody. I'm looking at holding this fundraiser as an opportunity to help somebody. It's like they say, what comes around goes around."

Hart sent an e-mail to Tate, and Tate contacted him. When Hart told him his intentions to hold a fundraiser, Tate gave his blessing.

"All he is saying is, 'thank you, thank you, thank you,'" Hart said.

Hart will hold the fundraiser Saturday at his rural home. It will run from noon to midnight, and feature food, drinks and lots of games to play.

Tate's wife, Carol, said she is happy someone is willing to help.

"(Hart) said he's getting things rolling," she said.

Hart printed flyers, and has distributed more than 150 of them so far. He plans to canvass his town, and drop an invitation off at every home displaying a U.S. flag. He also will post notices at a nearby veterans' museum and walk around his neighborhood to personally invite people to his basement club.

The fundraiser will be held in Hart's basement, an area he outfitted with a bar, two jukeboxes, pinball machines and other fun stuff a few years ago after he realized he was one of the older patrons of a sports bar near his home.

"I started my own NCO club," he laughed.

While the "club" started as a fun place for Hart to hang out, it is now opened frequently to raise funds for men and women in uniform. With the proceeds, Hart and his wife, Linda Lou, who was a Navy nurse in the Vietnam War, send special packages to those serving overseas. They've sent coffee, food, snacks, hand-held radios, DVD players, T-shirts from a Hooters restaurant - and anything else the soldiers request.

"It's all about boosting morale," Hart said.

They also open their home regularly to traveling members of the military on active duty. There's a guest room set aside for the soldiers, and the game room is open to them and any other service personnel visiting the area.

"For a few of them, it was the last fun time they had before they went to Iraq because some of them are no longer here," Hart said. A photo of an Army staff sergeant who visited the Harts hangs on one of the walls, paying tribute to the man who died from injuries suffered when his vehicle hit a roadside bomb. Photographs of other visitors also line the walls, as do military-themed items, movie posters, album covers and mannequins.

"I'll do whatever I can to help the veterans. I can't help everybody, but I can help one person," Hart said.

jwhalen@standardspeaker.com, 570-455-3636

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Also See: Vietnam veteran running out of options

Liver transplants must be started in Kuwait

Updated on: 16/08/2010

Miami University team to train local doctors

Dr Hussein Hayati is a liver, pancreas and organ transplantation specialist. Along with his team of surgeons and hospital officials, he is working on starting liver transplantation in Kuwait; a process he says is much needed in the country.

Fortunately, he and his team are on the verge of finalizing an agreement with an American team from the university of Miami and a liver transplant unit has been established at the Amiri Hospital currently catering to cancer surgeries and surgical diseases related to the liver, pancreas and the biliary system. These surgeries have also only begun to be performed in Kuwait.

“Kuwait is in need of liver transplantation and we have the facilities to establish this system and if we work hard on deceased donation, we can do 15 to 20 if not more liver transplantation a year. This may reduce the number of people going outside and reduce the costs. A liver transplantation can cost a person a minimum of one million dollars abroad. Liver transplantation will be free of charge here; the expenses will be for the investigations only,” said Dr Hayati.

He added that liver transplantation, procedures are necessary as currently doctors are loosing patients who could have been saved, especially young patients who are nationals and non-nationals.

Q: What does liver transplantation consist of?

A: Liver transplantation is like any other organ transplantation,transferring an organ or organ tissue from a donor to a recipient. It is done in two ways, either you take the liver from a deceased person or brain-dead person or you take it from a living donor who could be a relative or someone with matching criteria.

The diseased liver of the recipient could also be replaced by a piece of liver from the donor. We connect this piece of liver to the recipient and with time the liver grows into almost the size of the liver that he or she needs.

Q: What is the criteria for being a recipient or a donor?

A: Liver transplant is done on those who have liver cirrhosis or liver failure. Liver cirrhosis is the end result for any chronic disease that affects the liver. The most common liver diseases are viruses; we have Hepatitis C and Hepatitis B. They cause chronic illnesses and inflammation which will result is cirrhosis, which means the liver tissue will be replaced by fibrous tissue that is inactive.

There are other causes of chronic liver illness such as alcohol consumption, which is the second common cause for liver failure in the world. Then we have hereditary causes and congenital causes. Either you have enzymatic deficiencies or metabolism problems which these days affect children. However, the most common causes are Hepatitis and alcohol.

Q: What are the most commonly used techniques for liver transplantation?

A: Liver transplantation is done surgically, either transplanting a complete liver or a piece of liver. The techniques for both surgeries are the common. However, if you take the liver from a liver donor it is more time consuming and needs a lot of work because you will end up with two rooms, one for the donor and one for the recipient.

The donor will be under anesthesia and a team will work on him or her to take a piece of liver. Sometimes you need a small piece and sometimes you need a bigger piece. The bigger piece is taken from the right lobe of the liver in adults. In pediatrics, we can take segments. The liver has eight segments and these segments are divided into two lobes anatomically.

That’s why I mentioned piece of liver, cause it could be for a child, they take a segment or two segments of the liver. But if it is an adult, they take either the left or right side, but usually the right side.

The techniques of surgery are slightly different when a piece of liver from a live donor is taken because surgeons will be dealing with smaller liver tissue as well as smaller vessels and ducts that need to be connected. It is more time consuming, if liver is taken from a live donor.

Q: How successful is the live donor liver transplant surgery? How long does it take the recipient and the donor to recover?

A: Usually fit donors with no medical problems are chosen for the surgery, so that you don’t end up with problems during the anesthesia or after the surgery. Their hospital sty is usually five to seven days and then they are discharged. After that it takes three months for the liver to reform and grow to normal size, plus or minus ten percent, and it will appear that no surgery was ever performed.

The situation for the recipient is different and he will take more time to recover because the recipient has taken in a foreign organ to his system or body. He will end up taking medication to reduce his immunity, called immuno-suppressive medication. He will be taking four kinds of medication and then he will be discharged with three kinds which are, with time, withdrawn slowly. If the transplant is from a live donor, the liver will also grow to about normal size.

If a whole liver is transplanted, the recovery time and medications will be the same but the surgery itself is less complicated. The surgeon will be dealing with large structures, bigger vessels and ducts that drain the biliary system, so it is easier to connect the organ to the body.

The life expectancy of a liver transplant recipient depends on the cause of the liver cirrhosis or liver failure. It is divided into viral and non-viral. Viral diseases are Hepatitis B and Hepatitis C. Non-viral causes are alcohol, hereditary problems, congenital problems or enzymatic deficiencies, which is a congenital problem.

Recipients with non-viral liver failure have the best outcome than recipients with viral problems. That is because viruses can come back again when immunity is low and cause damage to the transplanted liver. That is why with the non-viral, we are talking about 95 percent, one year survival and we call it graft survival. It can reach to almost 80 percent, five year survival and ten years you can go to 70 percent.

Recipients with viral disease also divided into two categories; the ones with Hepatitis B and the ones with Hepatitis C. Hepatitis C is the worst because we do not have the proper anti-viral to counteract the effects of the virus.

After the first year of the transplant, there is a 60 percent chance the virus will reoccur. But the amount of damage varies, for some people within three months the liver is completely damaged and they need a re-transplantation. Some people can last for three, four or five years even without any problem.

On the contrary, we have certain antibodies and anti-viral for Hepatitis B. That is why the outcome for Hepatitis B is much better than Hepatitis C. The recurrence of Hepatitis B after transplantation in the transplanted liver is 11 percent. There used to be an 80 percent chance of recurrence, but due to the discover of the anti-viral and antibodies that are included in the treatment regiment, it lowered the chance of recurrence.

Q: Has liver transplantation ever been done in Kuwait?

A: Liver transplantation has not been done yet in Kuwait. We are on the verge of finalizing an agreement with an American team at the University of Miami. We already approached the team and they have visited Kuwait, but we are just waiting for the final agreement.

The team evaluated the facilities in Kuwait and has pointed out that we should start a liver transplant and liver surgery unit at the Amiri Hospital because, according to their evaluation, the Amiri Hospital has the best facilities such as a new ICU and new operating room to avoid infections in these kinds of cases.

Also, we have Al-Thunayan Gestural and Intestinal Center nearby so if we need intervention by endoscopies it is available.

It has been agreed upon by the heads of departments to locate that unite there and the services have already been opened up, but right now we are only doing specialized cancer surgery and operating on surgical diseases related to the liver, pancreas and the biliary system.

These surgeries have only begun to be performed in Kuwait. We have started doing them around a year ago but now we have a specialized place and a team and we are training the ICU and nursing staff to get used to these kinds of cases. We are getting transfers so far from three or four hospitals, excluding Mubarak Hospital.

We are performing one surgery a week because it is not a very common problem but the problem is still there and we are still new and people are still getting used to us. For example, we don’t get transfers for private hospitals, so we need to build a good reputation.

We have the support of the Ministry of Health because we have ministerial decree to establish the unit and to establish the referral system from other hospitals to this unit. So all these specialty surgeries related to the liver, pancreas and the biliary system are done in our unit.

Q: When do you expect liver transplantation to begin in Kuwait?

A: It depends when we get the agreement. There are certain financial issues not finalized yet, but hopefully by the end of this year or early next year.

Q: How necessary is liver transplantation in Kuwait?

A: It is very necessary and we need it. We are loosing patients and especially young patients who are nationals and non-nationals. The non-nationals have Hepatitis C more frequently and the nationals get Hepatitis B often and there are some cases of cirrhosis of an unknown origin, but it is non-viral and non-alcoholic, it can happen like that because there is an entity called idiopathic, we don’t know the cause. There is a small percentage of alcohol related cases as well.

Kuwait is in need of liver transplantation and we have the facilities to establish this system and if we work hard on deceased donation, we can do 15 to 20 if not more transplantation a year. This may reduce the number of people going outside and this may also reduce the cost. A liver transplantation can cost a person a minimum of one million dollars abroad. Liver transplantation will be free of charge here; the expenses will be for the investigations only.

If the services are provided here, it will reduce the costs and it will be much more effective because we are losing young patients. Recently, only in the l last month, we lost an 18-year-old girl to chemical hepatitis. She took more herbal medication and she developed liver failure. She was put into intensive care and we rushed to send her abroad but we didn’t have enough time. She passed away before we were able to send her abroad.

If we had the liver transplant service here, we could have managed to rescue her. There were also similar cases like this one, we have another 28-year-old lady last year, a mother with three children, who took a medication for TB and had a bad reaction that ended with liver failure. We couldn’t save her live.

So the service has to be established and the MoH is working hard on that. They realized that we needed this. They have the expertise in all different specialties but it is just a matter or organization, plus they wanted an outside experienced team to come here so they will gain the trust of the people.

To be honest, there is a lack of trust in the medical services in Kuwait because of awareness problems and political issues. That is why the Minister of Health Dr Hilal Al-Sayer, made an excellent move by bringing in teams for the chest hospital, the cancer center and the transplant center because these are the three main areas we have not built upon in Kuwait. He provided the teams here so that there will be no excuse for going abroad.

Q: Do you have compiled donor list for liver transplantation?

A: We don’t have a donor list; we should have a recipient list according to blood group because evaluating a person consumes a lot of time and money. We cannot do that unless we reach an agreement and have a starting date. If this process takes longer, I have to evaluate the patient again because his status will change with time.

So if we reach an agreement and decide on a starting date, then we can arrange a list of people who are fit for transplants two months prior by contacting all the centers in Kuwait that deal with liver cirrhosis.

We already have 5,000 people with donation cards and their names are registered in Kuwait Society of Organ Transplantation but we are still working on the deceased donation list.

Any program in the world starts with deceased donation, because it is less complicated than living donation. You have to establish a good deceased donation program before you start a living donor program in case the living donors develop problems themselves or living donor transplantation surgeries go wrong.

Dr Mostafa Al-Mousawi is the head of the organ procurement department which started working toward this program in June and is developing a good system. Now we get a good number of reports from the ICUs, it is just that we need to convince the families to donate.

For example, someone who has had an accident and he is comatose in the ICU. We cannot take consent from him; we have to take consent from his family who may even not be in the country.

So the system is being established, it has been there for a long time and is the best system in the Gulf, but we had some drawbacks due to problems with the transplant coordinators. That is why we are sort of re-evaluating the system and the MOH promised to give us more facilities and to establish more teams.

The American team for liver transplantation will include not only surgeons, but physicians, anesthetists, radiologists and coordinators as well who will train out local coordinators. We will have an agreement to send our Kuwaiti coordinators to Miami to be trained and the non-Kuwaitis will be trained here by the Miami team.

So we will have coordinators with different nationalities to communicate with the families from all over the world, such as Egypt, Syria, India and Bangladesh.

Q: Have there been any unique surgeries done so far for the first time in the Gulf?

A: All what we are doing now is new in the Arabian Gulf and we did one case which was not done before in the ME, but these are not done frequently. We do surgeries for cancer of the liver, pancreas, gal bladder and biliary system or tumor and benign conditions that need surgery.

So far we did eight big surgeries since we started in June. We get referrals from different hospitals and some don’t need surgical intervention for the time being.

The case that we did that was unique is called ‘Synchronous Resection’ where we performed two surgeries at the same time on one patient. This patient had cancer of the colon that has spread to the liver. These surgeries are not frequently done because you need special situations and a dedicated and educated patient that can be aware of the risks.

You also need a two-team approach, a team that can handle the colon cancer and a team which can handle the liver, which was our team. When we evaluated the patient, who is 43 years old, we discovered that she had colon cancer and at the same time she had a big metastatic spread of the tumour to the liver. We decided to do the surgery and the patient had a smooth recovery and she was discharged home by day eight.

It is not the surgeries that matter it is the services that you have around. We had excellent ICU care at the Amiri Hospital, the team was superb. The nursing staff in the operating room was excellent as well. You cannot work alone; you need other services to support you and the patient. I hope in the future we get more referrals from different hospitals.

By: Nihal Sharaf
 
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Curing the incurable becomes a reality

Monday, 16 August 2010 15:00 Dr Nick Walsh .

“You’re negative,” I said and handed her the results. The smile turns to relief, then elation.

Years of living with the virus, six months of difficult treatment, then a six-month wait to see if the virus was completely eradicated.

She strode out of the consultation room and down the corridor clutching the vital result, with a spring in her step and renewed vitality. Along with the hepatitis C virus, the disease was now gone, as was the stigma. Normal life once again.

We live in world full of viruses – some well known, others not, still others awaiting discovery. They range from the irritating common cold to the devastating sociocultural phenomenon that is the human immuno-deficiency virus, or HIV.

The elusive nature of viruses have long defied medical science, none more so than viral hepatitis, which affects nearly half of the world’s population.

More than 500 million people are currently infected with some form of hepatitis.

Compare that with the 42 million worldwide now living with HIV – long considered a more lethal epidemic – and one can begin to grasp the scope and impact of hepatitis.

In addition to causing liver disease, hepatitis is also the most common cause of liver cancer. The virus falls into a series of alphabetical categories, with hepatitis A and B the most common, and treatable, forms.

Hepatitis C was discovered in 1989, and had been referred to prior to its identification simply as non-A, non-B hepatitis.

It is the most elusive and often deadly form of hepatitis, afflicting nearly 170 million people globally and claiming the lives of half a million people each year.

And until the late 1990s, there was no real hope of a cure. Progress has been steady since that time, and in 2010 we can almost refer to hepatitis C as a curable disease.

Just last year, the medical community watched transfixed as the latest drug trials for hepatitis C reported a 75 percent cure rate for a disease that has for so long defied treatment.

Hepatitis C, or HCV, behaves much like HIV by constantly changing to evade attack by the body’s immune system.

Interestingly, the body can clear the virus itself in about 25 percent of cases. This success rate depends on a number of factors, in particular a strong immune system. And unfortunately, up to 75 percent of those exposed to HCV see initial infection become chronic.

The time lag between initial infection and liver failure can be up to 25 years, so HCV remains largely a silent epidemic.

Most infections occur in the developing world, whereas treatment – often costing upwards of US$15,000 or more – is available mostly to people living in the developed world.

Fortunately, treatment for hepatitis C is available in Phnom Penh, and a number of people have already been cured. But the cost puts treatment out of reach for the more than half a million Cambodians living with the virus.

Successful trials have been achieved with a triple regimen of pegylated interferon, which boosts the immune system, and the antiviral drugs ribavirin and telaprevir. This cocktail saw a cure rate of 75 percent in trials reported recently in the New England Journal of Medicine.

A new antiviral drug, boceprevir, has also produced similar results.

Key to successful treatment is to attack the virus at multiple points in its life cycle in order to give the body’s immune system a better chance of destroying it.

The battle to eradicate hepatitis C is fierce, and it has attracted considerable investment by the pharmaceutical sector.

Not surprising, as 4 million Americans and a similar number of Europeans – as well as millions across developing Asia – are potential candidates for treatment.

Medical researchers are looking for the holy grail, a combination of tablets much like treatment for HIV, as well as a shortened treatment cycle, dropping from the current six to 12 months down to three or less.

Cost remains a crucial factor if the developing world is to benefit from recent and forthcoming breakthroughs.

However, greater awareness of the threat of hepatitis C, and now its potential cure, is vital, and community activists have begun the difficult task of spreading the word.

So the once incurable hepatitis C virus has become less elusive and in some cases curable, but like so many other things it depends on where and under what circumstances you live.

In the end, it will be the strength of the community voice to spur continued research and access to treatment that will ultimately help confine hepatitis C to history and save countless lives in the process.

Normal life once again.

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Tackling cancer among poor doesn't have to cost dear

By Kate Kelland

LONDON
Sun Aug 15, 2010 7:04pm EDT

LONDON (Reuters) - The growing burden of cancer in developing countries could be reduced without expensive drugs and equipment, scientists said Monday, but it requires a global effort similar to the fight against HIV/AIDS.

In a study in the Lancet, scientists from the United States, who have formed a Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC), said cancer is now a leading cause of death in poor nations but is often neglected in health authorities' prevention and treatment plans.

While only about 5 percent of global resources for cancer are spent in developing countries, the burden of the disease is far greater there than in rich nations, with up to 80 percent of cancer deaths each year occurring in poorer nations.

"Cancer is no longer primarily the burden of high-income countries," the scientists, led by Felicia Knaul of the Harvard Global Equity Initiative, wrote in the study. "The time has come to challenge and disprove the widespread assumption that cancer will remain untreated in poor countries."

They said many cancers that make up the greatest burden in low- and middle-income countries, such as breast cancer, could be treated with drugs that are off-patent and can be manufactured generically at affordable prices.

They cited the breast cancer drug tamoxifen as one example and said that in Malawi, Cameroon and Ghana the total cost of generic chemotherapy drugs with a 50 percent cure rate for a type of cancer called Burkitt's lymphoma could be as low as $50 per patient.

"These drugs should be a focus of cancer treatment programs, rather than expensive on-patent drugs," they wrote.

According to GTF.CCC, rates of cancer in low- and middle-income countries have increased dramatically from 1970, when they accounted for 15 percent of newly reported cancers, to 2008 when that figure rose to 56 percent. The proportion is expected to rise to 70 percent in 2030.

More efforts against smoking, a major risk factor for many cancers which threatens to cause a surge in cancer deaths in Africa in the next decade, would be one relatively cheap way of making an impact, they said, as would increasing awareness about the importance of early cancer detection and screening.

Another intervention with huge potential, they said, would be vaccination against human papillomavirus (HPV), to help prevent cervical cancer, and against hepatitis B virus (HBV), to help prevent liver cancer.

GlaxoSmithKline and Merck & Co make vaccines against HPV and many drugmakers have HBV vaccines but these are often too expensive to be included in the health programs of low- and middle-income countries, the scientists said.

The group criticized what it described as "the public health community's assumption" that cancer could not be treated in poor countries and compared it to "similarly unfounded arguments from more than a decade ago" about treatment for HIV and AIDS.

Major advances in prevention, health services and efforts to bring down drug prices have dramatically increased the number of people in poor countries who have access to HIV treatment.

Knaul's team said like HIV and AIDS, cancer was now "an urgent health and ethical priority" in developing countries.

(Editing by Janet Lawrence)

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