Extrahepatic cancer risk increases after HCV SVR

   
Caen, France - Extrahepatic cancer was more common in patients with hepatitis C and was the leading cause of death in patients who achieved sustained virologic response compared with the general population, according to results of a French cohort study. “A sustained viral response (SVR) in HCV patients and maintained viral suppression (MVR) by nucleos(t)ide analogues in HBV patients have changed the clinical course of viral cirrhosis during recent decades,” Manon Allaire, MD, from the Hospital Center University of Caen Normandie in France, and colleagues wrote. “Our results suggest a role for viral replication in the carcinogenesis of lymphoproliferative disorders, although the mechanism by which HCV may cause hematological malignancies remains unclear.” Allaire and colleagues prospectively followed 1,671 patients with HCV, hepatitis B, or coinfection for a median of 59.7 months (range, 37.2-80.7 months). During follow-up, 225 patients developed primary liver cancer (PLC) and 93 patients developed extrahepatic cancer (EHC). The 5-year cumulative incidence for PLC was 13.4% and was significantly higher in patients with HCV vs. those with HBV or coinfection (P = .01). After adjusting for age, PLC was more common in patients with HCV compared with the general population (P < .001). The 5-year cumulative incidence for EHC was 5.9%. Excluding HBV, patients with HCV had a higher risk for EHC compared with the general population (P = .017). Patients with HCV who achieved SVR after interferon therapy were less likely to develop PLC (1.46 per 100 person-years; 95% CI, 1.02-2.09) compared with those who underwent direct-acting antiviral therapy (2.57 per 100 person-years; 95% CI, 1.23-5.4). In contrast, the incidence of EHC was higher in those who achieved SVR after IFN (1.59 per 100 person-years; 95% CI, 1.13-2.25) compared with those who underwent DAA therapy. Older age (P < .001) and SVR (P = .047) correlated with a higher risk for EHC after multivariate analysis. Among those with HCV, risk factors for EHC included older age among those who did not achieve SVR (P = .002) and diabetes for those who achieved SVR (P = .031). “Because DAAs are now being used in larger numbers of HCV-related patients with cirrhosis, the occurrence of PLC is expected to decrease; however, this population will live longer and will be exposed to new types of complications such as EHC, which represented the fourth most common cause of death in the cohort and the leading cause in patients who had achieved viral control,” the researchers concluded.
 

For more information: https://tinyurl.com/yd9rwlrw
 

Hep C World News - Week of December 23, 2018

New strains of hepatitis C found in Africa   
 

Glasgow, Scotland - The largest population study of hepatitis C in Africa has found three new strains of the virus circulating in the general population in sub-Saharan Africa. The research from the Wellcome Sanger Institute, the MRC-University of Glasgow Centre for Virus Research and collaborators suggested that certain antiviral drugs currently used in the West may not be as effective against the new strains and that clinical trials of patients in sub-Saharan Africa are urgently needed to assess optimal treatment strategies in this region. Published in the Journal Hepatology, the discovery of the new strains could inform hepatitis C treatment and vaccine development worldwide, and assist the World Health Organisation's aim of eliminating hepatitis C globally. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is transmitted mainly by needles and exposure to blood products. Infection can cause cirrhosis and liver cancer, and nearly 400,000 people die from hepatitis C each year. Globally, an estimated 71 million people have chronic hepatitis C infection, 10 million of whom live in sub-Saharan Africa and there is no current vaccine. In 2016, the World Health Organisation announced its aim to eliminate hepatitis C as a public health problem by 2030 globally. In the western world, direct-acting antiviral drugs are effective against multiple strains of the virus, and are currently tailored towards strains found in high income countries such as the US and the UK. However, research on HCV in sub Saharan Africa and other low income regions has been extremely limited. Access to diagnosis and treatment is low, and it is not known if different places have the same strains of the virus. This will have a huge impact on eliminating hepatitis C worldwide. To investigate HCV in sub-Saharan Africa, researchers carefully screened the blood of 7751 people from the general population in Uganda and, using molecular methods, found undiagnosed HCV in 20 of these patients. They sequenced the HCV genomes from these and two further blood samples from people born in the Democratic Republic of Congo (DRC) and discovered three completely new strains of the virus, in addition to some strains seen in the west. Dr. George S. Mgomella, joint first author on the paper from the Wellcome Sanger Institute and University of Cambridge, said: "In the largest study of hepatitis C in the general population in sub-Saharan Africa to date, we found a diverse range of hepatitis C virus strains circulating, and also discovered new strains that had never been seen before. Further research is needed as some antiviral drugs are effective against specific strains of hepatitis C virus and may not work as well in these populations." Dr Emma Thomson, a senior author on the paper from Glasgow University, said: "It is important that there is a concerted effort to characterise hepatitis C strains in sub-Saharan Africa at a population level in order to assist countries to select optimal treatments for national procurement. It will also be important to inform vaccine design which would catalyse the elimination of hepatitis C by 2030." The researchers discovered that current screening methods using antibody detection were inaccurate in Uganda and that detection of the virus itself would likely be a superior method for diagnosing the infection in high-risk populations. The researchers found that many of the strains present carry mutations in genes known to be associated with resistance to some commonly used antiviral drugs, proving that careful approaches are needed to diagnose and treat HCV effectively in Africa. Dr Manj Sandhu, a senior author on the paper from the Wellcome Sanger Institute and University of Cambridge, said: "Our study highlights the need for more investment on people in Africa and developing parts of the world. We show there are clear differences in HCV across the world, underlining the need for understanding HCV globally. Our work will help inform public health policy and reveals that further studies and clinical trials in sub-Saharan Africa are urgently needed if the WHO is to achieve its vision of eliminating hepatitis C by 2030".
 

For more information: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
 

Hep C World News - Week of December 16, 2018

Millions of Egyptians screened for Hep C since launch of eradication campaign 
 

Cairo, Egypt - Egypt's Minister of Health Hala Zayed has announced that nearly 19 million citizens have been screened for Hepatitis C and other non-communicable diseases as part of the '100 Million Lives' campaign, the largest-ever nationwide campaign to eradicate hepatitis C launched last October. Zayed affirmed that a total of 6.5 million citizens have been screened for the virus since the launch of the campaign's second phase by the end of November. The initiative aims to examine between 45 and 52 million citizens out of a population of 104 million. The first phase of the three-phase campaign lasted until 30 November and included the governorates of Damietta, South Sinai, Matrouh, Port Said, Alexandria, Beheira, Qalioubiya, Fayoum and Assiut. The second phase included Cairo, Beni Suef, Sohag, Menoufiya and Kafr El-Sheikh governorates. According to 2015 statistics, 22 percent of the population carried hepatitis C. Over the past three years, Egypt has been successful in the intensive use of a variety of new medications to combat the virus. In 2016, the health ministry achieved a 96 percent cure rate of the disease nationwide. The health ministry has vowed to completely eliminate the disease in Egypt by 2021.
 

For more information: http://english.ahram.org.eg/News/320323.aspx
 

Hep C World News - Week of December 9, 2016

Hepatitis C and the US opioid epidemic 
 

Atlanta, GA - New figures from the US Centers for Disease Control and Prevention (CDC) show that approximately 4.1 million adults are hepatitis C virus (HCV) antibody positive and approximately 2.4 million – about 1% of the US adult population – are HCV RNA positive, indicating active infection. These figures are based on 2013-2016 NHANES findings along with additional data on incarcerated and homeless people, nursing home residents and those in the military. This figure represents a decrease of around 1 million since the advent of direct-acting antivirals, suggesting that the number of people achieving a cure may now exceed the number of new HCV infections. Nevertheless, CDC estimates that 41,000 people were newly infected with hepatitis C in 2016. Study results show that HCV prevalence is highest in states heavily impacted by the ongoing opioid epidemic. West Virginia, Tennessee and Kentucky are the states with the highest prevalence. Looking at the MappingHCV dataset, researchers found some improvements in hepatitis C screening and linkage to care in the United States. Five million people were screened for hepatitis C in 2016 compared with four million in 2013. The proportion who received confirmatory HCV RNA testing to check for chronic infection increased from 45% in 2013 to 76% in 2016. Of these, 63.9% had chronic infection. The study found that young adults diagnosed with hepatitis C were less likely to receive treatment, regardless of whether they saw a specialist or primary care physician. The researchers said that as well as stepping up efforts to screen older people, US healthcare providers also need to develop screening programs that can reach younger people who may be less engaged with health care and less likely to be covered by health insurance.
 

For more information: https://tinyurl.com/y8ssygfy
 

Hep C World News - Week of December 2, 2018

Local pharmacies to test for hepatitis C   
 

Richmond, BC - London Drugs joins other community organizations offering testing for the curable liver-targeting virus. People in Richmond will have one more option to find out if they have hepatitis C as London Drugs joins other community organizations offering testing for the curable liver-targeting virus. The drugstore chain rolled out in-pharmacy hepatitis C testing at some of its Lower Mainland locations earlier this fall, and on Nov. 19 will begin offering it at its Ironwood location. As was reported by Richmond News, “We want to provide a convenient way for people to access care,” said Jane Xia, manager of special pharmacy services. The test involves a quick finger-prick, and 20 minutes later the pharmacist can read the patient their results and connect them with a physician if it looks like they’re producing hepatitis C antibodies. The province estimates 73,000 people in B.C. are living with the virus, and one in four don’t know they have it. But the good news is there’s effective treatment available. In March, B.C. followed Ontario to extend public coverage of hepatitis C medication to anyone diagnosed with the virus. Previously, people who didn’t have drug plans would have had to pay $45,000-$50,000 for a round of treatment. The province would fund it in certain cases, but only if there was advanced liver damage. At London Drugs the tests cost $24, a fee which covers the testing kit itself, Xia said. The pharmacy is the latest option available for getting tested for hepatitis C, but community organizations around the Lower Mainland have been pushing to get baby boomers and people from immigrant communities tested since the beginning of the year, with grants from Gilead and the Public Health Agency of Canada. Public health workers with the Vancouver Infections Diseases Centre visit a language class in Richmond to administer free cheek-swab tests for hepatitis C and HIV. They’re paying particular attention to people in immigrant communities, since hepatitis C is considered endemic (greater than two per cent prevalence) in much of the world outside North America, and people may immigrate to Canada without knowing they have the virus.
 

For more information: https://tinyurl.com/yd3mxynt
 

Hep C World News - Week of November 25, 2018

Trial shows Mavyret highly effective in untreated cirrhotic patients

San Francisco, CA - An 8-week course of glecaprevir/pibrentasvir (Mavyret) was highly effective in treatment-naive patients with hepatitis C virus (HCV) genotypes 1,2, 4, and 6 infection with compensated cirrhosis, with no reported virologic failures, a researcher said here. In an open-label, phase IIIb trial, sustained virologic response (SVR) rate at week 12 was close to perfect -- 100% in a per-protocol analysis and 98% in an intention-to-treat analysis, reported Robert S. Brown Jr., MD, of Weill Cornell Medical College in New York City. An 8-week duration of glecaprevir/pibrentasvir is approved for treatment-naive patients with HCV genotypes 1-6 without cirrhosis, Brown noted in a presentation at the annual Liver Meeting, sponsored by the American Association for the Study of Liver Diseases (AASLD). But registrational clinical trials showed that a 12-week course of treatment yielded a 99% SVR12 rate in treatment-naive patients with compensated cirrhosis, he added. However, the 8-week course of the therapy had not yet been studied in treatment-naive patients with compensated cirrhosis, which is what the ongoing EXPEDITION-8 trial aimed to investigate. Researchers enrolled 280 treatment-naive patients with HCV genotypes 1, 2, 4, and 6, but not genotype 3, to start. Brown said that "based on data emerging from ENDURANCE-3 and other studies, a second group was added of HCV genotype 3 treatment-naive patients, with anticipated enrollment of 60 subjects." Treatment-naive adults were eligible for inclusion if they had HCV genotypes 1, 2, 4, or 6 and cirrhosis, which was defined as both a FibroTest ≥0.75 and APRI ≥2. Any discordant results required FibroScan ≥14.6 kPA, or biopsy showing cirrhosis. Patients also had to have a Child-Pugh score ≤6, and any patients with hepatocellular carcinoma, hepatitis B, HIV, or past or current evidence of decompensated cirrhosis were excluded. Median patient age was 60, 60% were men, and 80% were white. The majority had HCV genotype 1 infection, about a quarter had history of injection drug use, and about a third had NS5A polymorphisms at baseline, Brown said. He explained there were seven patients excluded from the per-protocol analysis, six of whom were deemed "treatment failures," though there were no virological failures reported. Less than half of patients reported adverse events, and there were six serious adverse events reported, including duodenal ulcer hemorrhage, pyelonephritis, and atrial fibrillation. None of these were drug-related, and there were no adverse events leading to drug discontinuation. Moreover, there were no liver-related toxicities or cases of drug-induced liver injury, the authors said. Given that there were no new safety signals and no virologic failures, Brown said that these results supported an 8-week duration of glecaprevir/pibrentasvir for this population.
 

For more information: https://www.medpagetoday.com/meetingcoverage/aasld/76333
 

Hep C World News - Week of November 18, 2018

Pregnant women at risk for HCV benefit from universal screen  
 

San Francisco, CA - Universal screening of pregnant women at risk for hepatitis C virus (HCV) infection was a more efficient and cost-effective diagnostic approach than risk-based screening, researchers said here. In a sample of nearly 20,000 pregnant women, universal screening was associated with an increased odds of a patient demonstrating a positive RNA result (OR 1.8, 95% CI 1.5-2.3, P<0.001) and confirmed active infection (OR 2.1, 95% CI 1.4-3.0, P<0.001). However, universal screening did not increase the likelihood of a positive HCV antibody test compared with a risk-based approach (odds ratio 1.1, 95% CI 0.9-1.4, P=0.346), reported Michelle Rose, MBA, of Norton Healthcare in Louisville, Kentucky, and colleagues. They also found that universal screening was more cost-effective than risk-based screening in this population, with universal screening demonstrating an incremental cost-effectiveness ratio of $2,905, which is "well below the willingness-to-pay threshold" set at $100,000 per quality adjusted life year gained, Rose told MedPage Today. "Risk-based antibody screening alone missed a significant number of pregnant women not being correctly identified with active infection and thus not being able to link them to care," Rose said during a presentation at the annual Liver Meeting, sponsored by the American Association for the Study of Liver Diseases (AASLD). "Universal screening seems to cost-effectively increase the likelihood that infected pregnant women were identified and therefore can be linked to care and treated." Rose said that including the reflex RNA PCR portion of this test during a patient's initial screening could reduce the chance of false-positive antibody tests, and could expedite how quickly patients are referred to treatment. "By streamlining the testing and diagnostic process and universally screening, what we found is that it actually shortened the time by which a patient knows their [HCV] and could be linked to proper care," Rose said. Jordan Feld, MD, MPH, of the Toronto Western Hospital Liver Center, said faster linkage to care could prevent the disease from spreading and that it may provide a platform on which providers and patients can more easily discuss existing risk factors that may have before gone unnoticed. "Even if you can't treat people, there are really important benefits for linking people to medical care, and treating them before their next delivery," he said. "I think it's a really good opportunity to engage them in harm reduction around their injection drug use."
 

For more information: https://tinyurl.com/ydcfarlp
 

Hep C World News - Week of November 11, 2018

Widespread Hep C treatment should be offered to people who inject drugs 
 

Vancouver, BC - The overall number of people re-infected with hepatitis C (HCV) after successful treatment with direct-acting agents (DAAs) was small in a large population-based study from Canada, providing more evidence to offer widespread treatment to high-risk populations. But the key to eliminating HCV is to get treatment to HCV-infected people who have high-risk behaviors quickly to reduce the number of people living with infection. This in turn would reduce the passing on of the disease to others who have cleared the virus from treatment, said Naveed Janjua, PhD, senior scientist with the British Columbia Centre for Disease Control. In fact, the study, published in the Journal of Hepatology, found evidence that people who inject drugs (PWID) who continued to use opiate agonist therapy after successful cure with direct-acting antiviral therapies (DAAs) had lower re-infection rates than PWID who had no opiate-agonist therapy or supports. "These results highlight the need for engaging PWID with ongoing risk in harm-reduction and prevention services following treatment to reduce re-infection risk and to achieve World Health Organization (WHO) HCV elimination goals," the authors wrote. While there is still some resistance in the medical community for using high-priced drugs for populations who are at high risk of re-infection, these people simply may not be familiar with these populations and the evidence, Janjua said in an interview with the Reading Room. "Some people are resistant because they don't have adequate knowledge about what the possibilities are and what could be done to reduce re-infection." Janjua also noted that this high-risk population tended not to be treated during the interferon era for a variety of reasons including severe side effects, low success rates, and perceived compliance issues with the long-term regimens. But with DAAs, side effects are rare, the drugs are easy to take, and compliance is not an issue, he said. The study used data from the British Columbia Hepatitis Testers Cohort (BC-HTC) and was designed to examine how frequently re-infection with HCV occurred after successful treatment with DAAs. The BC-HTC includes data on 1.7 million individuals screened for HCV in Canada's province of British Columbia. Researchers followed 4,114 HCV-infected individuals successfully treated with DAAs for re-infection for a median of 123 days. Re-infection was defined as a positive RNA measurement after sustained virologic response (SVR). Of all study subjects, 875 individuals recently used drugs and 1,793 had used drugs in the past. Most were male (65%) and born before 1975 (83%). Re-infection rates, not surprisingly, were higher among both recent and former PWID, the researchers found. Also, rates were higher among PWID born after 1975 and those co-infected with HIV. These risk factors were also found in a previous study by the same researchers. But the study found that only a total of 40 patients became re-infected at some point with HCV after treatment with DAAs and achieving SVR. Most of these were PWID, except for only three re-infections. These three individuals may also be PWID but may not have been classified as PWID based on the definitions used in the study, Janjua and co-authors pointed out. Still, it is a very small number of cases of re-infection as it relates to the population as a whole. This means from a big economic view, the high cost of the medications for a small number of individuals should reduce the overall costs to a wider population by reducing the rate and spread of the disease, and not having to treat complications downstream.

For more information: https://tinyurl.com/hepcanada
 

Hep C World News - Week of November 4, 2018

CDC estimates nearly 2.4 million Americans living with Hepatitis C  
 

Atlanta, GA - New data highlight urgent need to diagnose and cure more Americans, and to address rising infections due to U.S. opioid crisis. Nearly 2.4 million Americans – 1 percent of the adult population – were living with hepatitis C from 2013 through 2016, according to new CDC estimates published today in the journal Hepatology. Medications that cure hepatitis C offer the hope of eliminating the disease in the U.S., yet, today’s report suggests that millions are infected and have not benefited from these new treatment options. Expanded testing, treatment, and prevention services are urgently needed, especially in light of the surge in new infections linked to the opioid crisis. “Every American who has been cured of hepatitis C is living proof that ending this epidemic is possible,” said CDC Director Robert R. Redfield, M.D. “Hundreds of thousands of Americans have already been cured. In order to achieve our goal, we must commit to ensuring that everyone living with hepatitis C is tested and treated.” To estimate total hepatitis C prevalence in the United States, researchers analyzed blood test results from the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2013 through 2016. They also analyzed data from other studies of groups not surveyed in the NHANES, including active duty members of the military, and people who are incarcerated or homeless. Adding to the burden of those already living with hepatitis C, separate CDC surveillance data indicate that the number of new infections each year in the United States is disturbingly high and on the rise. Acute hepatitis C cases reported to CDC more than tripled from 2010 to 2016, with most new hepatitis C infections due to increased injection drug use associated with the nation’s opioid crisis. Based on these data, CDC estimates that more than 41,000 Americans were newly infected with hepatitis C in 2016 alone. “Seeing an undiagnosable infection become a curable disease has been a public health highlight of the past 30 years. But the shadow of the opioid crisis puts our nation’s progress at risk,” said Jonathan Mermin, M.D., director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Tackling hepatitis C requires diagnosing and curing people living with the virus and cutting off new infections at the source.” Hepatitis C now poses a serious health threat to three generations of Americans, all of whom need to be reached with prevention services, testing, and treatment.

For more information: http://www.cdc.gov/nchhstp/newsroom
 

Hep C World News - Week of October 28, 2018

Generic Epclusa, Harvoni coming in USA

Foster City, CA - Gilead Sciences announced plans to launch authorized generic versions of Epclusa and Harvoni, according to a company press release. The generics will launch at a list price of $24,000 for the most common course of hepatitis C therapy in January 2019 through a newly created subsidiary, Aseguea Therapeutics LLC. “Launching these authorized generics is the best solution available to us today to quickly introduce a lower-priced alternative to our HCV medications without significant disruption to the healthcare system and our business,” John F. Milligan, PhD, president and CEO of Gilead Sciences, said in the lease. “This launch also will hopefully help increase transparency by more closely aligning our medications’ list prices with their cost.” The authorized generics of Epclusa (sofosbuvir/velpatasvir) and Harvoni (sofosbuvir/ledipasvir) will be priced to reflect the discounts that health insurers and government payers currently receive, according to the release. Additionally, Gilead stated that the generics should provide substantial savings for patients with Medicare or Medicaid. “Our ultimate goal is to lower the list price of Epclusa ... and Harvoni,” Milligan said in the release. “We are committed to working with all of our partners in the healthcare system to help enable list price reductions of our HCV medications and find better solutions to reduce patients’ out-of-pocket costs.”
 

For more information: https://tinyurl.com/ycxz9qvr
 

Hep C World News - Week of October 21, 2018

Decriminalization is one powerful force to ease the overdose crisis
 

Toronto, ON – An opinion piece by Andre Picard that was published recently in the Globe and Mail is worth repeating. An excerpt follows. “Decriminalization is not a silver bullet,” federal Health Minister Ginette Petitpas Taylor said at the Opioid Symposium which was held in Toronto. It’s a well-worn Liberal talking point and it’s technically correct, of course. There is no simple, magical solution to the complex, multi-faceted opioids crisis. But by taking decriminalization off the table, the federal government is tying one hand behind its back, making the implementation of other solutions unnecessarily complicated. Most people who use drugs don’t have a drug problem. Rather, they have a fear of prosecution problem. When possession of drugs is a crime, it creates giant barriers to harm reduction and treatment. First and foremost, it means drugs will be supplied by criminals, and the supply will be unregulated, potentially unsafe and over-priced. This, in turn, means more overdoses, more deaths and more hospitalizations. It also means more crime because those who are addicted and constantly chasing a  high will take whatever means they have to get their drugs – including stealing and sex work – and risk yet more criminal sanctions. Those problems won’t disappear with decriminalization, but measures such as drug-checking are facilitated and, if safety of supply becomes a priority, governments can opt to legalize and regulate, as they are doing with cannabis. Time and time again at the Opioid Symposium, the example of Portugal was cited as one for Canada to follow. Again, Ms. Petitpas Taylor cast that idea aside, saying “Portugal and Canada are two very different countries.” It is indeed imprudent to try to import policies from other jurisdictions without regard for cultural and political differences. But what we should seek to understand is how Portugal managed to dramatically reduce its overdose problem. A country of 10 million, in the early 2000s it was recording 360 fatal overdoses annually; now, that number is down to 26. With more than 4,000 overdose deaths a year and a population of 36 million, Canada’s challenge is orders of magnitude greater. Unlike Portugal, which had a heroin problem, Canada is dealing with street drugs tainted with fentanyl as well as over-prescription of opioids.
 

For more information: https://tinyurl.com/yb3w9emw
 

Hep C World News - Week of October 14, 2018
 

Egypt to launch largest anti-Hepatitis C campaign ever in October  
 

Cairo, Egypt - Egypt will launch the "largest medical campaign in the world" next October to detect and treat Hepatitis C virus for 50 million citizens upon President Abdel Fatah al-Sisi’s orders, according to Wednesday statement by Presidential Spokesperson Bassam Rady. On August, Rady said during a phone interview on "Saleet Al Tahrir" TV show that the ministry is conducting the scan as a prelude to the new health insurance project. The scan includes 50 million citizens in order to spot any patients with Hepatitis C virus and other diseases such as hypertension and diabetes. The scan is expected to take place from October 2018 till April 2019 in all Egyptian governorates. President Abdel Fatah al-Sisi has previously directed to swiftly finalize preparations for launching the comprehensive health insurance project, putting into consideration the mechanization of the venture and various State institutions. He also ordered providing the needed capabilities to equip the hospitals where the health insurance system will be applied. These remarks came during his meeting with Health Minister Hala Zayed and Director of EL-Galaa Medical Complex Bahaa Eldin Zidan. President Sisi also directed to examine 50 million people to treat Egyptians of hepatitis as well as non-communicable diseases (NCDs) such as hypertension and diabetes in order to contribute to early detection of diseases and offer treatment to patients. Egypt's anti-Hepatitis C initiative is considered the biggest of its kind in the whole world. In the same context, the head of the National Committee for Liver Viruses at the Ministry of Healh Wahid Dos told Egypt today that the virus has decreased to 90.000 cases annually. Dos pointed out that the treatment and detection will be free to all citizens.
 

For more information: https://tinyurl.com/y92lhwnj
 

Hep C World News - Week of October 7, 2018

New screening project in BC to identify Hep C    
 

Vancouver, BC - Now, a new pilot project seeking to screen adult British Columbians is hoping to change the situation was recently profiled on Global News. Five London Drugs locations in the Lower Mainland are offering screening through a new $24 finger-prick test called OraQuick HCV that can turn results around in just 20 minutes. Dr. Alnoor Ramji, a hepatitis C specialist and clinical associate professor of medicine at UBC, said the program is designed to help identify people unknowingly living with the virus, and connecting them with treatment options. Recent advancements in medicine now mean that hepatitis C can be cured in most people in months. He said that’s important, considering that people living with it put themselves at risk of cirrhosis of the liver, liver cancer or even total liver failure. The campaign is specifically focused on baby boomers and new Canadians, both of whom have a much higher rate of Hep C than the general public. He said an estimated 75 per cent of people who have the disease were born between the years of 1945 and 1975. But Ramji said convincing them to get tested remains the biggest barrier because of the way people think about hepatitis C. “That’s the biggest concern. Baby boomers have hepatitis C, and many of them have not used injection drugs, there’s no history of blood transfusion or tattoos and when you say hepatitis C, there is so much stigma.” Hepatitis is commonly transmitted by contaminated needles, but in rarer cases can also be contracted through sexual activity, or coming in contact with someone’s blood — for example, on a personal care item like a razor or toothbrush. Ramji said there will be a poster and information campaign at the participating pharmacies, along with counselling services on hand in case someone does test positive for the virus. The goal is to see screening become a part of people’s regular check-ups with their GPs one day, but in the meantime, anyone who sees the posters shouldn’t hesitate to get tested. “If you are of that age group of baby boomers… yes, period, end of discussion.”
 

For more information: https://globalnews.ca/news/4435278/hepatitis-c-screening-london-drugs/
 

Hep C World News - Week of September 9, 2018

Supervised drug sites working 
 

Ottawa, ON - The CBC recently reported that Ottawa's medical officer of health has told the Ontario government's new health minister that supervised consumption sites in the city are working and showing drug users that someone cares. In July, Health Minister Christine Elliott announced a review of provincial funding for supervised consumption sites. The next month, approvals for all new sites were put on hold until further notice. Dr. Vera Etches, Ottawa's medical officer of health, said at Monday's board of health meeting she sent Elliott a letter soon after that, arguing the evidence is clear the sites are helping. "Evidence shows they help reduce overdoses and transmission of blood-borne diseases, and community issues such as public drug use and discarded needles," she said. Etches said the four sites in Ottawa are helping patients make long-term changes. "It has allowed us to form relationships with clients who maybe were previously only picking up needles and leaving," she said. Ottawa's medical officer of health, Dr. Vera Etches, has written to the province's minister of health to recommend continued funding for supervised drug consumption sites. With those relationships, Etches said nurses are able to help users with some of the underlying issues and deal with their addictions, she said. Etches said the city sends regular reports to the province about the number of people using the services, but she also wants the minister to hear more than just the numbers. "It tells part of the story. I think what I tried to convey is that data is one thing, the actual experience of our nurses in the centres is another." In her letter, she encouraged Elliott to make sure front-line staff were heard during the review. Ottawa Public Health operates a supervised injection site in the ByWard Market with provincial funding, one of four sites in the city. Elliot's press secretary told CBC in an email the review will be done "in short order." "Our government is committed to get people struggling with addiction the help they need," she said, pointing to $1.9 billion committed to mental health over 10 years by Ford during the election campaign. "[Elliot] is actively involved in this process, has toured multiple sites and heard from people with lived experience along with experts, health care workers, community leaders, community members, police services, business owners and other stakeholders." Since Elliott announced the review of provincial funding, three new sites that had been proposed were put on hold because the province would not commit funds.
 

For more information: https://tinyurl.com/ycww5rr4
 

Hep C World News - Week of September 2, 2018

Decriminalization is no silver bullet, says Portugal's drug czar 
 

Vancouver, BC - An opinion piece by Daphne Bramham was recently published in the Vancouver Sun that looked at how Portugal took on the problem of drug addiction. Following is an excerpt from the article that appeared on Sep 8, 2018. Lisbon > In the 1990s, Portugal was in the throes of a national crisis, averaging 360 drug overdose deaths a year in a country of 10 million. Today, it has one of Europe’s lowest rates of drug, alcohol and tobacco use and the number of overdose deaths in 2016 was 26. Almost every day, foreigners knock on João Goulão’s door seeking a solution to their countries’ drug addiction problems. Goulão is Portugal’s director-general of drug policy and the architect of its radical approach, which included decriminalizing all drugs for personal use. Among the pilgrims who have come here are philanthropist Richard Branson, Canadian Justice Minister Jody Wilson-Raybould and, recently, an army of politicians and policy-makers from Norway. Fortunately, the former family doctor is infinitely patient, as he’s been answering the same questions for almost 20 years. In the late 1990s, Goulão and 10 others were charged with advising the government how to deal with the 100,000 people — one in every 100 citizens — using heroin. Overdose deaths were averaging 360 a year in the country of 10 million and Lisbon was called the junkie capital of Europe. Goulão was an unusual choice. He had no training in addictions and, rare among Portuguese, no direct connection with addictions. The closest family connection he has to drugs is a niece, who is in her 40s and living in a therapeutic community with schizophrenia caused by drug use. As for his four children, “Hopefully, none of them will have problems.” Because of its interventions, Portugal now has one of Europe’s lowest rates of drug, alcohol and tobacco use across all ages, and the lowest infection rates for HIV/AIDS and hepatitis that are associated with injection drug use. In 2016, the number of overdose deaths dropped to 26 from 40 the previous year. The only thing that most outsiders know about Portugal’s laws is that all drugs for personal use are decriminalized. But what most fail to understand is that all drugs, other than alcohol and tobacco, remain illegal. If police find you with illicit drugs, you’ll be arrested and taken to a police station where the drugs will be weighed. If the amount is above the strictly enforced threshold limits — designed to be a 10-day supply for personal use, or 25 grams of cannabis, five grams of cannabis resin, two grams of cocaine, or one gram each of ecstasy or heroin — you can be charged as a trafficker. If convicted, jail terms range from one year to 14 years. If the amount is below the limit, you’ll be sent the following day to the Commission for the Dissuasion of Drug Addiction — even if you’re a tourist. There, you will be interviewed by a psychologist or social worker before appearing before a three-person panel that will offer suggestions aimed at stopping your drug use. From there, you’re fast-tracked to whatever services you’re willing to accept. If you refuse help, you can be asked to do community service or even, eventually, facing a fine, perhaps even having possessions confiscated and sold to pay the fine. It’s why Goulão is so quick to point out that Portugal’s success isn’t because of decriminalization. It’s because, in 2001, his country made a commitment to providing whatever its citizens need to be as healthy and as fully engaged in society as possible. “Decriminalization is not a silver bullet,” he said. “If you decriminalize and do nothing else, things will get worse. “The most important part was making treatment available to everybody who needed it for free. This was our first goal.” Underlying the policies is a national conviction that addiction is a chronic, recurring disease best dealt with through treatment not jail. “Our approach is based on respect,” said Goulão. “It’s incremental. Our system works by asking citizens what he can give at that given moment. “If he is completely dependent, I cannot appeal through force of will. I have to help him with his limited capacity to make his own choices. And, step-by-step, the ability of the citizen increases.” Portugal created pathways to health that aren’t punitive. This required investing in treatment and recovery services and establishing a network that connects citizens to whatever they need in a timely manner, whether that’s outpatient counselling, time in a detox centre, even up to three years in a therapeutic recovery community. And it meant that the government made a long-term commitment to ensuring that those services wouldn’t disappear when the economy crashed in 2008. One of Europe’s poorest countries before 2008, Portugal was essentially insolvent after the global meltdown. The US$115-billion bailout from the International Monetary Fund and the European Union came with strings. The government had to increase taxes and cut spending. Yet, the addictions treatment and recovery services survived almost unscathed.
 

For the complete article: https://tinyurl.com/y77cnffs
 

Hep C World News - Week of August 26, 2108

Toronto doctors safely transplant lungs from hep C-infected donors 
 

Toronto, ON - Toronto doctors have successfully transplanted lungs from deceased donors with hepatitis C into patients in need of the lifesaving organs, followed by treatment to prevent them from becoming infected with the potentially liver-destroying virus. Since October, surgeons at Toronto General Hospital have performed the transplants in 11 patients as part of a pilot study to evaluate the safety of using lungs from hepatitis C-infected donors — a previously untenable idea. That’s because antiviral drugs can now cure the disease in 98 per cent of people infected with hepatitis C, which affects an estimated 250,000 Canadians, about 40 to 70 per cent of them unaware they harbour the blood-borne virus. “With the opioid crisis and persistent high rates of intravenous drug use, we have a great number of potential lung donors who are hepatitis C-positive, many of whom didn’t even know they were sick when they were alive,” said Dr. Marcelo Cypel, a thoracic surgeon at TGH and principal investigator of the study. “The current protocol is to not use these organs, but we started to question if that still made sense in an era when direct antiviral agents can cure hepatitis C,” he said. So last fall, the researchers embarked on the study, with a goal of enrolling 20 patients in desperate need of a lung transplant. What makes these transplants possible is the use of a dome-like device known as the ex-vivo lung perfusion, or EVLP, system developed at TGH in 2008. Donor lungs are bathed in a special solution for six hours, allowing doctors to evaluate their condition and assess their suitability for transplant. In the case of those from hepatitis C-positive donors, perfusion removes about 85 per cent of residual blood in the lungs that carries the virus. Within two to four weeks after the transplant, recipients are tested for hepatitis C and started on a 12-week course of the antiviral drugs to prevent infection of the liver, where the virus naturally takes up residence. Over time — often decades — inflammation caused by the virus can lead to severe cirrhosis or liver cancer. So far, eight transplant patients have finished treatment for hepatitis C and are now virus-free; two are still being given the drugs; and one is yet to receive the medication. Eva Runciman, 52, of St. Thomas, Ont., who had developed end-stage chronic obstructive pulmonary disease, or COPD, was among those enrolled in the study. A long-time smoker, she had reached the point where she needed to be hooked up to an oxygen tank. “I had trouble breathing if I walked, if I stood to do dishes, if I had a shower,” recalled Runciman, who quit smoking three years ago. At first she had balked at the idea of a lung transplant, but reconsidered when both her daughter and son said they were about to become new parents, her daughter for the second time. “I just thought it would be pretty great being a grandma a couple of more times,” said Runciman, who agreed to have lungs from a hepatitis C-infected donor, if they were the first to come available. Following her single-lung transplant in February and subsequent antiviral treatment, “I am absolutely clear” of the virus, she said. “I feel really good.” Cypel believes the new protocol will provide “a huge boost in organ donation,” adding roughly 1,000 more donors per year in North America, where about 2,600 lung transplants are performed each year. In Canada, there were more than 240 patients waiting for a lung transplant in 2016, and about one in five died while on the list because there weren’t enough donor organs. “So I think it’s a big gain and patients will get transplanted sooner as well, as more organs become available for transplantation,” Cypel said. Dr. Jordan Feld, a TGH liver specialist and study co-author, said the transplant surgeons approached him about initiating the trial after they noticed a sharp rise in the rate of hepatitis C-infected donors. Part of that increase has been attributed to the opioid crisis, which has resulted in more young people dying of overdoses as well as being infected with the virus, which can be transmitted through shared needles. “Obviously, when you first think about infecting someone, it raises some concerns,” Feld said of patients receiving organs from hepatitis C-positive donors. “But we also recognized that these people are on a transplant list waiting for a life-saving organ, and without a transplant or even a delay in their transplant, it can sometimes be too long a wait and there can be grave consequence if they have to turn down these organs.” The study results were to be discussed at the Global Hepatitis Summit, a gathering of international clinicians and researchers that was held in Toronto.
 

For more information: https://toronto.citynews.ca/2018/06/14/hepatitis-c-lung-transplant/
 

Hep C World News - Week of August 19, 2018

Affordable treatment leads to fewer deaths from hepatitis C  
 

Adelaide, AU - There has been a 20% decline in deaths from hepatitis C, new Kirby Institute data presented today at the Australasian Viral Hepatitis Conference in Adelaide shows. The decline, based on New South Wales data from more than 100,000 people with a hepatitis C diagnosis, is the first large scale evidence of the impact of new hepatitis C treatments on liver-related mortality in Australia. In the decade before new treatments were available, there had been a three-fold increase in the number of people with hepatitis C dying from liver failure and liver cancer. Professor Greg Dore from the Kirby Institute said: “This decline reflects the high uptake of direct-acting antiviral therapies among people with hepatitis C, particularly those with more advanced liver disease. Since 2016, around 60,000 Australians have been treated with these highly curative therapies, and now for the first time, we are seeing fewer people dying of hepatitis C related causes,” said Professor Dore, head of the Viral Hepatitis Clinical Research Program at the Kirby Institute, based at UNSW Sydney. These oral treatments first became available in 2014, but high costs made them inaccessible. Following price negotiations with the pharmaceutical companies, the Australian Government placed these treatments on the Pharmaceutical Benefits Scheme in March 2016, making them widely accessible in Australia. “The data we’re presenting today directly relates to the estimated 70% of people with hepatitis C related liver damage that have started treatment since 2016, so we can expect to see further reductions in mortality,” said Professor Dore. “But, more broadly, only 30% of people living with hepatitis C in Australia have been treated, so we need to continue to raise awareness about these life-saving treatments.” Australia is one of the only countries in the world to offer hepatitis C treatments at low cost, without restrictions based on a patient’s stage of liver disease or injecting drug use behaviours, and where general practitioners can also prescribe. People who inject drugs are a key population for hepatitis C treatment and prevention, and related Kirby Institute research has shown that prevalance of active hepatitis C infection among this group declined from 43% to 25% between 2015 to 2017. Dr Jennifer Iversen from the Kirby Institute analysed national data from people who inject drugs attending needle syringe programs and will present the results at the conference in Adelaide today. “Over the past two years, the proportion of people who inject drugs with hepatitis C who have initiated treatment has increased dramatically, from 10% to 41%. This, combined with the reductions in prevalence of active hepatitis C infection, tells us that people who inject drugs are not only taking up hepatitis C treatment, but that they are also seeing their treatment through, and being cured of hepatitis C,” said Dr Iversen. “This is life-changing news for the individuals who’ve been cured of hepatitis C, but it has important population-level impacts, because when there are fewer people with hepatitis C infection, there is a decreased risk of transmission occurring.” The findings on the numbers of people dying from liver disease and the burden of hepatitis C among people who inject drugs, mean Australia is in a good position to meet World Health Organisation hepatitis C elimination targets, which are to reduce deaths by 65% and new infections by 80% before 2030. Increasing treatment above current levels will achieve these targets even earlier. The Australasian Viral Hepatitis Conference is the leading multidisciplinary viral hepatitis conference in Australasia. It is taking place in Adelaide from 13 -15 August 2018. On Sunday 12 August at a general practitioner forum held ahead of the conference, GPs pledged to raise the number of people treated for hepatitis C to over 10,000 per year by 2025.

For more information: https://tinyurl.com/y9gon73p
 

Hep C World News - Week of August 12, 2018

Patients disease free one year after HCV infected kidney transplant  
 

Philadelphia, PA - Patients who were negative for hepatitis C virus and received HCV-infected kidneys and antiviral treatment were clear of the disease and experienced good renal function up to a year after transplantation, according to study results recently published in the Annals of Internal Medicine. “This pioneering trial involved transplanting kidneys from donors with [HCV] infection into recipients without HCV, followed by antiviral treatment,” Peter P. Reese, MD, MSCE, associate professor of medicine and epidemiology, University of Pennsylvania Perelman School of Medicine, said. “The 20 participants received a kidney transplant quickly, were able to avoid years of dialysis, had good quality of life and were successfully cured of HCV. Up to 1 year later, the kidney transplants functioned as well as kidneys from donors without HCV.” Reese and colleagues conducted an open-label, nonrandomized trial of 20 HCV-negative candidates for kidney transplantation surgery. The patients received kidneys infected with genotype 1 HCV and were treated with elbasvir-grazoprevir 3 days after the surgery. Ten patients were part of the Transplanting Hepatitis C Kidneys into Negative Kidney Recipients (THINKER) trial, for which the researchers had reported 6-month outcomes in 2017. The study estimated 12-month HCV-treatment outcomes, estimated glomerular filtration rate (GFR) and quality of life for those patients. Ten additional transplants with kidneys from HCV-infected donors were performed, with 6-month data gathered for those patients. HCV cure, defined as sustained virologic response at 12 weeks or undetectable HCV RNA 12 weeks after completion of HCV therapy, and adverse events attributable to HCV infection or therapy at 1-year follow-up were primary outcome measures. RAND-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) quality-of-life scores and enrollment after transplantation, and post-transplant renal function in comparison with recipients of HCV-negative kidneys were exploratory outcomes. “The aims of the study were to determine HCV treatment outcomes and adverse events in the expanded cohort of 20 patients, assess whether allograft function showed any evidence of durable injury from HCV, and describe trajectories in quality-of-life recipients after transplant of HCV-infected kidneys,” the researchers wrote. The transplant recipients in the study had a mean age of 56.3 years (70% male, 40% black). Diabetes was the most common cause (45%) of end-stage renal disease. The 20 patients underwent transplant with HCV-infected kidneys of 15 donors. The researchers reported that the transplant recipients in the study were anticipated to have prolonged waiting times for HCV-negative kidney transplants and were less likely to have conditions that would elevate the risk for liver disease, death or allograft failure after transplant. All transplant recipients achieved a 100% HCV cure rate. The patients experienced a decrease in mean PCS and MCS quality-of-life scores at 4 weeks. In subsequent measurements, PCS scores increased above pre-transplant values, and MCS scores were similar to baseline values. “Because of the opiate crisis, many organ donors have hepatitis C,” Reese said in the interview. “Kidneys from deceased donors with hepatitis C are valuable and can improve the lives of patients who are suffering on dialysis. Well-informed patients and their doctors should know that accepting organs from donors with hepatitis C may be worth considering to get the benefits of transplant.”
 

For more information: https://tinyurl.com/yaf6jv8z
 

Hep C World News - Week of August 5, 2018

In UK deaths from hepatitis C have fallen by 11 per cent in the last year 

London, England - New data published by Public Health England (PHE) show that deaths from hepatitis C-related end-stage liver disease have fallen by 11% in 2017 compared to the previous year. A fall has been sustained in 2017 after a continued rise in deaths over the last decade. This fall is most likely due to increased use of new antiviral medications now available on the NHS which have the potential to cure the condition in most cases and have fewer side effects than previously used medications. More people are accessing treatment than ever before with an increase of 19% on the previous year and of 125% when compared to pre-2015 levels. The new data also shows there was still an average of 1,974 new end-stage liver disease and cancer diagnoses per year, with the rate remaining stable between 2011 to 2015. In the UK, around 200,000 people have a long-term infection with hepatitis C virus. People who have ever injected drugs are most at risk of infection, but around half of people living with hepatitis C are unaware of their infection. PHE is urging anyone who has previously been diagnosed with hepatitis C or who has engaged in activities that may have put them at risk to get tested as they can benefit from this potentially curative treatment. Two years ago, the UK government committed to a joint ambition with 193 other countries to eliminate the disease as a public health threat by 2030. As well as testing and treatment, prevention through needle and syringe exchange services and opiate substitution therapies need to be sustained to achieve and maintain elimination. Dr Sema Mandal, Consultant Epidemiologist at PHE, said: The fall in deaths from hepatitis C related advanced liver disease in the last year suggests that more people are accessing new, potentially curative treatments and shows we’re making positives steps towards reaching our overall goal of elimination of hepatitis C as a major public health threat. However, more needs to be done. We are urging anyone who has ever injected drugs, even once or a long time ago, had a tattoo or medical treatment overseas where proper hygiene procedures may not have been followed, or has had a blood transfusion before hepatitis C screening was in place, to get tested at their GP, community drug services or sexual health clinic. It could save your life. If untreated, infection with the hepatitis C virus can lead to liver damage, cancer and even death. It is normally spread through blood-to-blood contact by sharing needles, but even sharing razors or toothbrushes with an infected person could pass the virus on. The disease often has no symptoms until it causes serious complications many years later. Urgent testing and prompt treatment is needed in order to ensure infected people don’t suffer from serious health complications in the future. If people aren’t sure about whether they are at risk, they can take a short quiz on the Hepatitis C Trust website to find out if they should get tested.
 

For more information: https://tinyurl.com/y9gheh8q
 

Hep C World News - Week of July 29, 2018

Physicians diagnosing, treating HCV define new role in opioid crisis 
 

Boston, MA - The opioid epidemic in the United States has affected millions, exposing them to health risks that include a range of infectious diseases. HHS estimates that in 2016, 11.5 million people in the U.S. misused prescription opioids. That year, 2.1 million did so for the first time, and the same number of people reported symptoms of an opioid use disorder (OUD). According to the NIH, studies suggest that people who misuse prescription opioids commonly progress to injection drugs like heroin. Injection drugs, in turn, have fueled a national hepatitis C virus epidemic and continues to expose many to HIV.  Opioid abuse can also lead to endocarditis, an infection of the heart chambers and valves; septic arthritis, an infection of the joints typically caused by bacteria that travel through the bloodstream; among other infectious diseases. “We’re seeing this increased burden of bacterial infectious sequelae — infectious endocarditis, skin and soft tissue infections like abscesses and osteomyelitis,” Benjamin P. Linas, MD, an associate professor of medicine at the Boston University School of Medicine and an infectious diseases specialist at Boston Medical Center, told HCV Next. “It is increasing across the country and is starting to fill up (infectious diseases [ID]) services. ... We need to start recognizing that part of our specialty is addressing opioid use disorder.” Experts like Linas say the ID physician’s role in the opioid crisis must extend beyond merely treating infections and include treating patients’ underlying addiction. HCV Next spoke to several experts about that approach, which begins with an understanding of the common health threats associated with addiction, especially HCV. In recent years, the CDC has reported worrisome trends among people who use opioids and rates of HCV transmission. From 2002 to 2013, heroin use in the U.S. increased by more than 60%, according to the agency. The agency estimated that about 34,000 new cases of HCV occurred in 2015. Thirty states reported an increase in new HCV infections of more than 200% from 2010 to 2014, with the largest increases among young people in nonurban counties. The CDC says the epidemic is driven primarily by injection drug use.
 

For more information: https://tinyurl.com/y7mjo82p
 

Hep C World News - Week of July 22, 2018

New opioid disaster may be coming to Ontario

Vancouver, BC - Fentanyl arrived in British Columbia in 2013, and overdose deaths increased gradually across the province. By the winter of 2016, we were seeing roughly 60 deaths every month, triple the number that was once considered "normal" in BC. Then something changed. There were roughly 60 fatal overdoses in September 2016, according to the BC Coroners Service. Then, in December, there were 160. It was frightening for neighbourhoods hard hit by the crisis. We didn't know what was going on. Vancouver's Downtown Eastside had struggled with fentanyl for several years and this was something worse. Months later, lab results confirmed drug users' suspicions. Just as fentanyl had contaminated the heroin supply years earlier, now carfentanil was poisoning Western Canada's fentanyl supply. Terry Lake was BC's health minister from June 2013 to June 2017, a period that includes the onset of BC's opioid epidemic as well as that scary winter, during which time he made several visits to the Downtown Eastside. "The late fall of 2016 was the tipping point," Lake said. "When November came, we realized... this situation was different than infection-based epidemics. That’s when I realized we needed a more drastic approach." Lake has a warning for the rest of Canada: Carfentanil is on the way. Fentanyl arrived in BC first and then moved east across Canada. Now carfentanil, a synthetic opioid significantly more toxic than fentanyl, is coming behind it. "Will we see carfentanil in Eastern Canada? Lake asked. "Absolutely." In Ontario, there were 743 overdoses associated with fentanyl last year, compared to 1,210 in BC, which has a population one-third the size of Ontario's. Both figures are up from 2016, when there were 353 fentanyl overdoses in Ontario versus 667 in BC. Differences in how BC and Ontario define and count overdose deaths make direct statistical comparisons difficult. Ontario numbers include prescription fentanyl obtained legally, for example, while BC's do not. But the data roughly shows that while both provinces are struggling with illicit fentanyl, Ontario is a year or two behind BC. And now carfentanil is on its way. It was first detected in Ontario in the Niagara region in a fatal overdose that dates to November 2016. Since then, only a few additional cases have occurred in Ontario. But Lake repeated it is very likely more are coming. "I hate to be a pessimist, but I can't see how you stop it," he said.

For more information: https://tinyurl.com/y9s2o8s8
 

Hep C World News - Week of July 15, 2018

Feds still aren’t fighting the right opioid battle 
 

Ottawa, ON - The federal government has taken plenty of action to try to curb Canada’s opioid-overdose crisis. It has aggressively expanded supervised injection sites across the country and made naloxone, a life-saving antidote to opioid overdoses, available without a prescription. It has stepped up enforcement efforts to weed out the import of illegal synthetic opioids and bust drug labs and traffickers on Canadian soil. But while Ottawa acts, the crisis deepens. Last year, 3,987 Canadians died from apparent opioid-related overdoses. That’s 1,126 more than the year before. The death toll from opioids is now greater than the toll from AIDS at the height of that epidemic. In the face of this horror, the latest announcement from Health Canada continues a streak of worthwhile but small-bore initiatives from a government that seems to grasp the seriousness of this disaster, but has not yet embraced the dramatic fixes that are really needed. Health Minister Ginette Petitpas Taylor recently unveiled a new enforcement team to investigate deceptive marketing practices by drug companies, while also calling on those firms to stop promoting opioids. (In the past, the department has only responded to complaints about improper marketing, rather than doing its own oversight.) There’s nothing wrong with this. Drug companies are certainly known to oversell the benefits and downplay the risks of their products. The notion, peddled by its maker Purdue Pharma, that OxyContin was less addictive than other opioids on the market had a leading role in the current crisis. But whatever merit the Health Ministry’s new marketing crackdown might have, it is unlikely to make a real dent in Canada’s opioid addiction problem. It might have made a difference in the mid-1990s, when pharma companies were newly selling opioids as a safe treatment for chronic pain. But that terrible myth took hold and now Canadians consume a shocking quantity of legal opioids – the second most in the world per capita after the United States. And while the infamously pernicious OxyContin was taken off the market in 2012, the proportion of opioid prescriptions given out in Canada that were for strong opioids such as morphine and fentanyl actually went up in the next five years. Story continues below advertisement In other words, there is no quick way of putting this genie back in the bottle. Canada is hooked on opioids. Millions of Canadians use the drugs for pain relief and can’t simply have their prescriptions cut off or severely curtailed without crippling withdrawal symptoms and the risk that they will opt for dangerous street drugs instead. British Columbia’s College of Physicians and Surgeons confronted this reality recently when it revised a 2016 standard of practice that called on doctors to limit opioid dosages to the equivalent of 90 milligrams of morphine a day. In part because of concerns that patients were being tapered off their meds too quickly, physicians in the province are now being advised to determine appropriate dosages in consultation with their patients. Of course, when so many people are being prescribed opioids in Canada, some of them are going to become addicted, or abuse the drug, and find their way to street versions – no matter what doctors do to try to prevent it. And today it is street drugs that are doing most of the killing. Almost three-quarters of the accidental opioid-related deaths in Canada last year involved fentanyl or its analogues. It appears that this is largely because those drugs are being cut into heroin and other illegal opioids. Users who are addicted and recreational users alike are being poisoned by unscrupulous dealers. Given this literal death spiral, two decades in the making, of easy opioid prescriptions leading to a spike in addiction leading to a spike in fatal poisoning by tainted street drugs, a move to further monitor pharmaceutical marketing practices that have already been tamped down is the definition of too little, too late. That’s not to say these moves are worthless. But the government needs to show more ambition in rethinking the way Canadians treat pain and addiction – a vast undertaking, requiring political courage and billions in funding – if it hopes to stem the tide of Canada’s worst public-health crisis in generations.
 

For more information: https://tinyurl.com/yc9585ft
 

Hep C World News - Week of July 8, 2018

UK drug policy isfFueling an HIV outbreak in Scotland  
 

Glasgow, Scotland - The UK Government’s continued opposition to the introduction of drug consumption rooms is fueling an HIV outbreak in Scotland. Scotland is enduring some of the worst consequences of the UK’s national drug policy. The rate of drug-related deaths in Scotland is eight-times the EU average, and close to three-times the rates of England, Wales, or Northern Ireland. Alongside this spiraling number of deaths, Glasgow – Scotland’s most populous city – is now seeing a resurgence in HIV, with people who use drugs bearing the brunt of the outbreak. Over 100 cases of HIV among people who inject drugs have been linked to this outbreak so far. A new policy briefing published by the National AIDS Trust (NAT) warned that attempts to reduce the spread of HIV have been “hindered due to a number of issues, in particular the UK Government preventing the opening of a Drug Consumption Room (DCR) in the city and the closure of one of the main needle exchange services in Glasgow”. A DCR would reduce the spread of HIV as it would allow people who inject drugs to do so with sterile equipment in a safe environment, overseen by medical professionals who ensure that injecting equipment is never shared or contaminated. As well as helping contain HIV’s spread, a DCR in Glasgow would reduce the city’s soaring drug-related death rate – which is ten-times higher than London’s – as those who experience overdoses can be immediately attended to. Across all ten countries that have introduced DCRs, not a single person has died of a drug overdose in one. Other benefits of DCRs include a reduction in potentially-hazardous drug litter in public, reduced pressure on emergency services, reduced crime, as well as economic benefits. It is, therefore, unsurprising that DCRs have gained considerable support in Glasgow. “[Glasgow’s NHS board] have recommended a DCR is implemented in Glasgow, and the initiative is supported by a range of stakeholders including the majority of MSPs and the local authority,” NAT’s briefing notes. “We call on the Government to allow the opening of a DCR in Glasgow either through an amendment to the Misuse of Drugs Act 1971 or by devolving law in relation to drug policy to the Scottish Parliament”. Despite these calls, the UK Government continues to oppose reform or devolution. Victoria Atkins, the minister in charge of drugs, recently said the Government would not endorse DCRs due to her concerns about "the challenges that DCRs place on law enforcement agencies as well as the implied acceptance of wider criminality". There is, however, no evidence that DCRs increase pressure on law enforcement. Rather, evidence suggests the opposite – DCRs allows police to concentrate on serious crime, while simultaneously allowing people under the influence of drugs to stay in a controlled environment. A July 6 statement by the policing minister Nick Hurd hinted at a potential change in the government’s approach. When asked a question on festival drug checking, Hurd described this harm reduction approach as "local operating decisions that we [the Government] are not standing in the way of", despite acknowledging the illegality of drug possession. The sentiment expressed could be equally applied to DCRs. With continued pressure, the Government may soon accept that DCRs are an important health-focused approach for countering the spread of HIV and reducing Scotland’s rate of drug-related deaths.
 

For more information: https://www.talkingdrugs.org/uk-drug-policy-fuelling-an-hiv-outbreak-in-scotland
 

Hep C World News - Week of July 1, 2018

Illicit drugs behind almost 80% of Ontario’s fentanyl-related deaths  
 

Toronto, ON – As reported by the Globe and Mail, Black-market forms of the powerful opioid fentanyl were responsible for nearly 80 per cent of fentanyl-related deaths in Ontario last year, according to the Office of the Chief Coroner. And nearly half of the people who died from accidental opioid-related causes in the province from May to December, 2017, had been taking the drugs for at least five years, Chief Coroner Dirk Huyer said. “We are seeing people who have used drugs for many years now dying, so something has changed,” Dr. Huyer said. The figures are the result of new investigative techniques adopted by the office last year to better understand what is driving a spike in opioid-related deaths in the province and who is being affected. There were 1,263 such deaths in Ontario last year, compared with 867 in 2016, the coroner said. Fentanyl, an opioid that’s up to 100 times more powerful than morphine, is responsible for rising rates of overdose deaths across Canada. Last year, 72 per cent of accidental opioid-related deaths in the country involved prescription or illicit fentanyl, compared with 55 per cent in 2016, according to a report released by the federal government last month. B.C. and Alberta have been particularly hard-hit, with fentanyl linked to about four-fifths of all accidental opioid deaths in those provinces last year. But Ontario is quickly catching up. Last year, 68 per cent of accidental opioid-related deaths were linked to fentanyl, compared to 45 per cent in 2016 and 21 per cent in 2016, according to Dr. Huyer. Of those, 78 per cent were caused by non-pharmaceutical fentanyl, which Ontario’s coroner defines as fentanyl not produced in a medical facility for intended use by patients. Typically, that black-market fentanyl is made to resemble other prescription opioid tablets, or is mixed with other hard drugs. (Other provinces don’t distinguish between pharmaceutical and non-pharmaceutical fentanyl in the same way. In B.C., for example, the chief coroner’s office says that illicit fentanyl can include pharmaceutical products that have been stolen or otherwise obtained from the intended patient.) Dr. Huyer said investigators are now examining details surrounding individuals’ deaths with greater scrutiny. For instance, looking at medical histories and previous drug-use habits help to paint a more complete picture. The office is also expediting investigations to allow for faster analysis of trends – instead of a year, most cases are being wrapped up in three months, Dr. Huyer said. The next step is to figure out what is driving more people toward fentanyl and other opioids by examining their lives to better understand the growing crisis and how to prevent more deaths.
 

For more information: https://tinyurl.com/y8bat66d
 

Hep C World News - Week of June 24, 2018

Turmoil of opioid epidemic is targeted in new hospital guide  
 

Boston, MA - Nurses tell stories of patients who overdose on illegal drugs in their hospital beds. Doctors fret over patients who come out of surgery, go into withdrawal, and flee the hospital. Security guards stand watch while hospital staff search a patient for pills or bags of heroin. "Every hospital in the state is dealing with this problem," said Dr. Deeb Salem, co-interim CEO at Tufts Medical Center. "It's more than difficult." Hospitals say there's been little guidance for them about how to screen patients for an opioid addiction, how to manage a patient in detox while treating injuries from a car accident, for example, and where to make naloxone available. (The recommendation on that last one is everywhere, including hospital hallways, bathrooms and cafeterias.) To remedy this gap, the Massachusetts Health and Hospital Association (MHA) is out with what it says is the first statewide "guide for patient management with regards to opioid misuse." It's a compilation of protocols collected from 13 hospitals in and outside of Massachusetts. "Everyone seems to be doing it differently," said Salem, one of the guide's authors. "We wanted to produce a guideline that would help hospitals with understanding and using medications and procedures that would make it safer for the patient and safer for the clinicians taking care of these patients." In addition to recommendations about screening and managing pain for patients addicted to opioids, the guidelines walk hospital staff who may not have worked with patients in withdrawal though the steps, using medications like methadone or buprenorphine to ease that process. Patients addicted to opioids arrive at hospitals with many health problems that aren't directly related to drug use. MHA's vice president for clinical integration, Steven Defossez, another co-author of the guide, mentions a heart attack or a gallbladder infection. "When someone comes into the hospital, if they are addicted to opioids, we know they will go into uncomfortable withdrawal symptoms within a matter of 12 hours or so," Defossez said. "What we wanted to do is develop a very compassionate program of medication-assisted therapy to keep people from going into withdrawal ... and this gives us the first step toward recovery for patients who chose to continue recovery on their discharge." The guidelines also address some thorny issues. "Searches," the guide says, "should not be more intrusive than necessary.... [They] should be performed with at least two staff present ... [and] except in an emergency circumstance, the patient must be informed as to the reason of the search." Visitors known to be at risk for using opioids, the guide adds, should be asked to sign a zero tolerance for drug use agreement that gives hospital staff the right to search the visitor and any gifts they bring. Visitors and patients who violate the agreement may be asked to leave. Salem, a cardiologist, says that's often a wrenching decision for doctors.
 

For more information: https://tinyurl.com/yb47khwo
 

Hep C World News - Week of June 17, 2018

Gut dysbiosis associated with HCV infection 
 

Nagoya City, Japan - New research finds patients with chronic hepatitis C (HCV) infection have lower bacterial diversity in their gut microbiota, even when their liver disease is less severe. A team of researchers in Japan wanted to know more about the gut microbiota of patients with HCV, and what effect, if any, progression of HCV had on gut bacteria. Takako Inoue, MD, PhD, vice director of the Department of Clinical Laboratory Medicine at Nagoya City University Hospital, said there were a number of reasons she and colleagues initially became interested in the topic of HCV’s effect on the gut microbiota. For one, it was already known that HIV infection was associated with dysbiosis, and HCV was already known to cause general viremia. Therefore, she wondered if HCV might cause gut dysbiosis. “Second, due to the anatomical location, the liver is exposed to gut-derived bacterial components,” Inoue said. “The gut microbial community is closely associated with the progression of liver diseases because of gut-liver circulation via the gut-microbiota-liver axis. Earlier research has shown that dysbiosis affects liver disease in a number of ways, including nonalcoholic fatty liver and nonalcoholic steatohepatitis. “We guessed that to elucidate the relationship between gut microbiota and chronic hepatitis C (would be) valuable to know about bacterial ecology in the body,” Inoue said. To investigate the relationship, the researchers looked at fecal samples from 166 chronic HCV patients and compared those samples to samples from 23 healthy patients. Those samples were examined via analyzed using 16S ribosomal RNA gene sequencing. Among the HCV-infected patients, researchers noted lower bacterial diversity compared to the healthy control patients. HCV patients’ gut microbiota showed a decrease in the order Clostridiales and an increase in Streptococcus and Lactobacillus. Even patients in the persistently normal serum alanine aminotransferase (PNALT) phase of the disease showed evidence of dysbiosis. Inoue said that suggests dysbiosis is a result of HCV, rather than a pre-existing factor. “PNALT patients show a significant increase in Enterobacteriaceae and genus Bacteroides compared with healthy individuals, a characteristic observed only in PNALT, not in advanced stages,” she said. “Based on these findings, I think that the altered gut microbiota is a result of HCV infection.” As a caveat, however, Inoue noted that the study also found aging and/or high Fib-4 indexes also were correlated with changes in gut microbiota. Administration of proton pump inhibitors also had a marginal, though not statistically significant, effect on gut microbiota. “Of course, advance of chronic hepatitis C (cirrhosis or hepatocellular carcinoma) can make gut microbiota altered,” Inoue added. Further research is needed to find out what treatment options might be possible to alter the gut microbiota. In theory, Inoue and colleagues said it’s possible that treating the gut dysbiosis might lessen the severity of the underlying liver condition. “If we can normalize the gut microbiota in patients with HCV infection, we think we can avoid endotoxemia and/or hyperammonemia,” Inoue said. “Therefore, we think normalization of the gut microbiota can be an innovative treatment.”
 

For more information: https://tinyurl.com/ybca9dgc
 

Hep C World News - Week of June 10, 2018

New guidelines recommend testing all Boomers for hep C   
 

Ottawa, ON Canadians born between 1945 and 1975 should be tested for the potentially liver-destroying virus hepatitis C, a new set of guidelines recommends. More than 250,000 Canadians are believed to be infected with hepatitis C, but an estimated 40 to 70 per cent are unaware they harbour the blood-borne virus because it can take decades before symptoms become evident. Chronic infection can lead to cirrhosis of the liver or liver cancer. The Canadian Association for the Study of the Liver, a national group of health-care providers and researchers, published its guidelines on testing and treating hepatitis C in a recent edition of the CMAJ. A key recommendation is that people be tested based on their age — not only possible risk factors, said Dr. Jordan Feld, a liver specialist at Toronto's University Health Network and a co-author of the guidelines. "And the reason we've done this is it just happens that somewhere between two-thirds and three-quarters of people with hepatitis C were born between 1945 and 1975 in Canada," he said. "So just the way someone gets a blood pressure check or a cholesterol check or a colonoscopy based on their age, we would recommend that they get a hepatitis C test if they're born between those years. "And if we do that, we hopefully diagnose the vast majority of people living with hepatitis C." The recommendations differ from those issued last year by the Canadian Task Force on Preventive Health Care in the same journal. " "As the landscape has evolved such that everyone can access therapy we felt much more strongly that then everyone who is at risk should be tested," said Feld's co-lead author, Dr. Hemant Shah, a liver specialist and clinical practice director of the Francis Family Liver Clinic at Toronto's University Health Network.
 

For more information: https://tinyurl.com/ycqtl4ym
 

Hep C World News - Week of May 27, 2018

Early HCV therapy reduces risk for non-Hodgkin lymphoma, stroke  
 

Baltimore, Maryland - Although sustained virologic response after antiviral therapy for hepatitis C reduces the risks for several extrahepatic manifestations, researchers found that early initiation of treatment may be required to reduce the risk for glomerulonephritis, non-Hodgkin lymphoma and stroke. “[Antiviral therapy] for HCV infection is beneficial for patients with HCV-associated mixed cryoglobulinemia or indolent [non-Hodgkin lymphomas (NHLs)], as they can have complete resolution of symptoms of cryoglobulinemia and lymphoma regression,” Parag Mahale, PhD, MPH, from the National Cancer Institute, Maryland, and colleagues wrote. “However, this risk reduction was not observed when [antiviral therapy] was started 2 or more years after the HCV index date.” Mahale and colleagues retrospectively reviewed the data of 160,875 adults with HCV from the Veterans Affairs HCV Clinical Case Registry, most of whom were men (97.1%), aged between 50 years and 59 years (52.1%), and had genotype 1 (54.7%). Approximately 19% of the patients received antiviral therapy, 34% of whom achieved SVR. Most extrahepatic manifestations had an incidence rate less than 1 per 1,000 person-years, including mixed cryoglobulinemia, porphyria cutanea tarda (PCT), lichen planus, NHL and coronary heart disease; whereas glomerulonephritis, diabetes and stroke occurred more frequently in all three patient groups: untreated, treated without SVR and treated with SVR. Glomerulonephritis, diabetes and stroke occurred less frequently in patients who achieved SVR compared with treated patients without SVR. Multivariate analysis showed that patients who achieved SVR had significantly lower risks for mixed cryoglobulinemia (HR = 0.61; 95% CI, 0.39-0.94), glomerulonephritis (HR = 0.62; 95% CI, 0.48-0.79), PCT (HR = 0.41; 95% CI, 0.2-0.83), NHL (HR = 0.64; 95% CI, 0.43-0.95), diabetes (HR = 0.82; 95% CI, 0.76-0.88) and stroke (HR = 0.84; 95% CI, 0.74-0.94) compared with untreated patients. Among those who did not achieve SVR, the risks for glomerulonephritis (HR = 0.82; 95% CI, 0.69-0.96) and stroke (HR = 0.82; 95% CI, 0.75-0.9) decreased significantly, while the risks for lichen planus (HR = 1.56; 95% CI, 1.22-1.99) and diabetes (HR = 1.14; 95% CI, 1.08-1.2) increased significantly. Finally, the researchers restricted analysis to treated patients and found that patients who achieved SVR had a lower risk for mixed cryoglobulinemia (HR = 0.55; 95% CI, 0.33-0.9), glomerulonephritis (HR = 0.75; 95% CI, 0.57-0.99), PCT (HR = 0.31; 95% CI, 0.14-0.65) and diabetes (HR = 0.72; 95% CI, 0.65-0.78) compared with those without SVR. The researchers observed gradual reductions in significance of antiviral treatment with increasing time from HCV index date for glomerulonephritis, NHL and stroke. Antiviral therapy showed the most significant protection when initiated at 1 or 2 years after HCV index date for glomerulonephritis and stroke, and at 1 year for NHL. “These findings further strengthen the epidemiological evidence for [extrahepatic manifestations’] association with HCV infection,” the researchers concluded. “HCV-related [extrahepatic manifestations] carry a significant economic burden due to direct medical costs and indirect costs due to loss of productivity. The results of our study emphasize the extrahepatic benefits of SVR.”
 

For more information: https://tinyurl.com/yconm5dx
 

Hep C World News - Week of May 20, 2018

HCV infection in teens on the rise  
 

Atlanta, GA - Along with the rise of hepatitis C infection rates among young adults is an unsettling increase in the rates of infection among teens. And studies show that the increase in this population goes hand-in-hand with increases in injection drug use resulting from the opioid crisis. But the rates of HCV infection may be underestimated, screening is not common in this population, and treatment protocols are only just starting to catch up with that of adults. The prevalence of HCV infection in children and adolescents has been reported to vary from 0.05% to 0.36% in the United States and Europe, to 1.8% to 5.8% in some developing countries -- and even that might be low. According to a review published in Hepatology Communications, the six genotypes seen in adults have been identified in children, with similar global geographic distribution as adults -- but that like adults, the younger cohort in the U.S. tend to have genotypes 1 through 3. The paper notes that while HCV infection in younger children tends to be from vertical transmission from HCV-infected mothers, in adolescents it is increasingly linked to intravenous drug abuse. In fact, one study from the Centers for Disease Control and Prevention shows a 364% increase in HCV infection among people ages 12 to 29 living in the Appalachian region of the U.S. between the years 2006 to 2012. Other routes of infection, the review authors noted, include receiving tattoos in an unregulated setting, intranasal cocaine use, and engaging in sexual practices that involve multiple partners and/or sexual activity with trauma. A recent study in The Journal of Pediatrics by researchers from the University of North Carolina (UNC) found that injection drug use is an increasing cause of HCV infection in adolescents nationally. The study examined patterns of children hospitalized for HCV infection from 2006 to 2012. Currently there are about 50,000 children living with chronic HCV in the U.S., the study noted. Using the Kids' Inpatient Database, an Agency for Healthcare Research & Quality resource that contains hospital-stay information for children ages 20 and younger from over 4,100 hospitals across the country, the researchers found that nationally, the number of hospitalizations for children infected with HCV increased by 37%. Most of these patients were adolescents, of whom one-third also had a substance use disorder.  
 

For more information: https://tinyurl.com/y83w47ol 
 

Hep C World News - Week of May 13, 2018

HCV finger-stick test accurate, gives results in 1 hour   
 

Sidney, Australia - A new hepatitis C virus finger-stick test can be used to diagnose infection in a single clinical visit, delivering results in 1 hour, according to researchers. The Xpert HCV Viral Load Finger Stick (Xpert VL FS, Cepheid) assay accurately detected active infection with HCV in point-of-care blood samples, they wrote in The Journal of Infectious Diseases. The results provide a way for clinicians to reduce the number of visits needed to diagnose HCV, they added. “This provides a major advance over antibody-based point-of-care tests, which only indicate HCV exposure,” researcher François M. J. Lamoury, senior research officer at the University of New South Wales Kirby Institute in Sydney, Australia, and colleagues wrote. “Further, the novel Xpert VL FS assay provides a substantial advance over the [current] Xpert HCV Viral Load assay, avoiding the need for plasma separation and enabling testing and diagnosis in 1 hour as compared to 2 hours, increasing the potential to move toward a single-visit diagnosis.” Current HCV testing includes two clinical visits, the researchers noted. In the first visit, clinicians test for HCV antibodies, which would confirm only that the patient has been exposed to the virus. A second visit includes testing for HCV RNA to determine the presence of active infection. Lamoury and colleagues cited previous studies showing that patients are lost to follow up because they do not return for subsequent visits, and that the process can be difficult without a phlebotomists and for people who inject drugs (PWID), whose veins can be difficult to access. The experimental assay’s predecessor — the Xpert HCV Viral Load assay — requires about 2 hours to provide results, which the researchers said was not conducive to providing a single-visit diagnosis. The new Xpert HCV VL FS assay is a redesigned version capable of testing a 100 µL sample of capillary blood. To test the newer assay’s potential to make diagnosis more convenient, the researchers enrolled participants between Aug. 3, 2016, and Dec. 13, 2016, at three drug treatment clinics and a service for homeless people in Australia. Each participant received a voucher worth 20 Australian dollars, or $15.75 at current exchange rates. The participants gave finger-stick capillary blood samples to be tested by Xpert HCV VL FS. They also gave venipuncture samples — the standard of care for HCV RNA testing — to be tested with the old Xpert assay. Participants also provided information about drug use and their knowledge of liver disease and HCV in a self-administered survey. A total of 223 participants enrolled, 72% of whom had a history of injection drug use, and 46% of whom had injected within the previous month of enrollment. Of the 210 participants with available XPert HCV Viral Load test results, 40% had detectable HCV RNA. The older assay’s sensitivity and specificity for HCV RNA quantification were both 100% (95% CI, 96.9-100 and 95% CI, 94.4-100, respectively). The Xpert HCV VL FS assay was had 100% sensitivity and specificity for HCV RNA quantification (95% CI, 93.9-100 and 95% CI, 96.6-100, respectively). “The finger-stick Xpert HCV VL FS test should be further evaluated as a screening tool for HCV RNA detection in high-prevalence settings, particularly in services for PWID,” they wrote. “In addition to broad direct-acting antiviral uptake, efforts to eliminate HCV as a global public health threat will require strategies to enhance HCV testing and diagnosis globally, including the development of assays for rapid detection of HCV RNA.”   
 

For more information: https://tinyurl.com/y9achdus
 

Hep C World News - Week of May 6, 2018

High rates of liver stiffness, fibrosis discovered in general population  
 

Barcelona, Spain - Researchers discovered an unexpectedly high prevalence of significant liver fibrosis, mostly related to nonalcoholic fatty liver disease, among a general population cohort of individuals with previously unknown liver disease, according to a recently published study. “The highest rates were observed among subjects with risk factors for NAFLD and subjects with increased alcohol consumption,” Llorenç Caballería, MD, from the Institut Universitari d’Investigació en Atenció Primària, Barcelona, and colleagues wrote. “Independent predictive factors associated with increased [liver stiffness] were mal e gender and components of the metabolic syndrome.” To assess the prevalence of liver fibrosis in the general population, Caballería and colleagues enrolled 3,014 individuals from an urban area of Catalonia, Spain, between Apr. 2012 and Jan. 2016. Participants underwent transient elastography to measure liver stiffness. Of the 179 participants with liver stiffness of 6.8 kPa or higher or increased ALT who accepted hepatology consultation, 92 consented to a liver biopsy. After liver biopsy, the researchers found 81 participants had NAFLD and seven had alcoholic liver disease. Among the participants with biopsy-proven liver disease, the researchers observed significant fibrosis in 32% of those in the 6.8 kPA or higher cut-off, 45% of those in the 8 kPa or higher cut-off, and 65% of those in the 9 kPa or higher cut-off. Final analysis showed that a cut-off of 9.2 kPa best predicted the presence of significant liver fibrosis with a sensitivity of 93%, specificity of 78% and predictive accuracy of 83%.The researchers suggest a 3-step algorithm for fibrosis screening in primary care: assess risk factors for liver fibrosis, including metabolic syndrome and alcohol risk consumption; exclude patients with a fibrosis liver index less than 60; and perform transient elastography in patients with risk factors and fibrosis liver index of 60 or higher. “These data highlight the relevance of NAFLD as a major health issue and suggests that effective screening, preventive and therapeutic measures should be taken to reduce the present and future impact of this disease in the population,” Caballería and colleagues concluded.
 

For more information: https://tinyurl.com/y7exvjlr
 

Hep C World News - Week of April 29, 2018

Icelandic HCV elimination program treats majority of patients 
 

Landspitali, Iceland - Since its launch in 2016, a hepatitis C elimination program in Iceland has treated approximately 56% to 70% of the estimated viremic population with direct-acting antivirals , according to a recently published update.“The idea was to offer DAAs to all HCV-positive patients within an entire population within a relatively short time frame and simultaneously initiate an observational study with long-term follow-up,” Sigurdur Olafsson, MD, FACP, Landspitali University Hospital, and colleagues wrote. “Gilead would, in a study setting, provide DAAs free of charge for the project.” The Treatment as Prevention for Hepatitis C in Iceland program, or TraP HepC, was designed to treat a majority of Icelanders  with HCV, including injection drug users. The concept was initially discussed in 2014 and then put into action in 2016. “With the TraP Hep C program, Iceland is taking a cohesive, multipronged approach that includes scale-up of prevention, testing and early treatment of hepatitis C in both hospital and community settings,” the researchers wrote. “It includes a multidisciplinary public health model of care and cooperation between government, health services, the penitentiary system and community organizations.” According to Olafsson and colleagues, Iceland has seen 40 to 70 new cases of HCV each year over the last 20 years with an estimated viremic population of 1,100 (range, 880-1,300) in 2014 for a population prevalence of 0.3% (range, 0.3-0.4). Most individuals with HCV in Iceland also have a history of injection drug use. During the initial phase from January to October 2016, all patients with HCV received treatment with Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) for 8 weeks to 12 weeks. Patients with genotype 3 also received ribavirin. After November 2016, all patients received Epclusa (sofosbuvir/velpatasvir, Gilead Sciences). The program also included an increased focus on screening efforts, especially among injection drug users, and improving harm reduction strategies in the country. The researchers estimated that an 80% reduction in domestic incidence is achievable by 2025 if a minimum of 75 out of 1,000 injection drug users are treated per year. If 188 of 1,000 injection drug users are treated per year, the same reduction rate may be achieved by 2020. “It has been estimated that by offering treatment to up to 200 patients every 4 months, the majority will be treated within the first two years of the program,” the researchers wrote. Additional goals of the project include measuring the short-term and long-term effects of the program regarding the incidence of HCV infection in Iceland, the incidence rates of cirrhosis and hepatocellular carcinoma related to HCV, virologic response rates, compliance to treatment, and prevalence among injection drug users over a 15-year span.“These data as well as the data generated during the project will be used to assess the effect of the intervention on the future burden of illness for patients and society,” the researchers wrote.Since its launch, 557 patients with HCV have been evaluated for an estimated range of 56% to 70% of the viremic population. Of those, 526 patients initiated treatment with DAAs, 37% of whom reported injection drug use within 6 months. “Although some parts of this program are empirical in nature and highly dependent on intangibles, such as vigilance and motivation amongst health care professionals and the public alike, it is hoped that treatment as prevention will lower the incidence and morbidity associated with HCV well in advance of the WHO targets,” the researchers wrote. “The results of Icelandic project will provide important data and inform others globally trying to achieve the WHO hepatitis C elimination goals.”

For more information: https://tinyurl.com/yc6vsjq9
 

Hep C World News - Week of April 22, 2018

Manage alcohol use while under DAA therapy   
 

New South Wales, Australia - An international study showed that alcohol use disorder contributed significantly to liver disease burden in patients with hepatitis C. Researchers suggest that, where appropriate, countries develop strategies that combine direct-acting antiviral therapy with management of alcohol use disorders. “Elimination of HCV infection as a public health threat by 2030 is defined by a 65% reduction in liver-related mortality and an 80% reduction in incidence compared with the 2015 baseline,” Maryam Alavi, PhD, from the Kirby Institute, New South Wales, Australia, and colleagues wrote. “To reach the 65% mortality reduction component of the elimination target, concentrated policy action is required to enhance HCV treatment uptake, and where needed, improve alcohol use disorder management at the national level.” Alavi and colleagues selected British Columbia, Canada; New South Wales, Australia; and Scotland for the study, as each has established surveillance systems for monitoring patients with HCV. The study comprised 58,487 people with an HCV notification from British Columbia, 84,529 from New South Wales, and 31,924 from Scotland. British Columbia had more patients born before 1965 (70%) compared with New South Wales (47%) and Scotland (28%). Scotland had a higher proportion of patients with alcohol use disorder (27%) compared with British Columbia (19%) and New South Wales (18%). While British Columbia had the highest proportion of patients with decompensated cirrhosis (4.6%) compared with Scotland (4.3%) and New South Wales (3.7%), Scotland had the highest proportion of patients with decompensated cirrhosis and alcohol use disorder (50%) compared with New South Wales (32%) and British Columbia (28%). Patients with alcohol use disorder, compared with those without the disorder, were younger at decompensated cirrhosis diagnosis in British Columbia (52 vs. 56 years; P < .001), New South Wales (48 vs. 52 years; P < .001) and Scotland (43 vs. 49 years; P < .001). Multivariate analysis showed that alcohol use disorder independently predicted decompensated cirrhosis in British Columbia (HR = 1.92; 95% CI, 1.76-2.1), New South Wales (HR = 3.68; 95% CI, 3.38-4) and Scotland (HR = 3.88; 95% CI, 3.42-4.4). For decompensated cirrhosis diagnoses, alcohol use disorder correlated with a population attributable fraction of 13% in British Columbia (95% CI, 11-15), 25% in New South Wales (95% CI, 23-27) and 40% in Scotland (95% CI, 36-44). Specifically, among people born in or after 1965, alcohol use disorder correlated with a population attributable fraction of 21% in British Columbia (95% CI, 16-25), 36% in New South Wales (95% CI, 32-40) and 48% in Scotland (95% CI, 43-53) for decompensated cirrhosis. “Continued heavy alcohol intake is likely to impact potential benefits of DAA-based cure on individual-level liver disease progression and population-level liver disease burden,” the researchers wrote. “Use of administrative databases for surveillance, particularly with the addition of individual-level antiviral treatment data will be a valuable tool for ongoing evaluation and comparison of the impact of DAA-based therapies on the individual-level liver disease progression and population-level burden of HCV, given differences in the epidemiology of HCV and HCV public health strategies across the three settings.”
 

For more information: https://tinyurl.com/y7reprcj
 

Hep C World News - Week of April 15, 2018

How to Reach a Difficult-to-Engage Population   
 

Sydney, Australia - As a population, people who inject drugs have the highest prevalence and incidence of hepatitis C infection as was reported by HCV Next www.healio.com/hepatology/hepatitis-c/news. Despite this, people who inject drugs have historically had difficulty accessing treatment, either due to socioeconomic and stigma-related barriers or due to treatment restrictions for people with ongoing drug and/or alcohol use. Data collected over the last few years have shown that people who inject drugs (PWIDs), recent or otherwise, have rates of adherence and sustained virologic response to interferon-free direct-acting antivirals comparable with the general population. “We’ve made a lot of headway in terms of treatment for people who inject drugs and the evidence has been building that therapy is safe and effective in this population,” said Jason Grebely, PhD, from the Kirby Institute, University of New South Wales, Sydney. “Addressing the low levels of screened and diagnosed is going to be one of the major barriers to HCV elimination going forward.” Hence, innovative screening techniques and linkage to care will be crucial in a population that includes many young individuals who may be unaware they have HCV or the burden it presents, individuals with economic and housing hardships, and a history of stigma that may prevent a patient from seeking medical attention. Additionally, to achieve global elimination of HCV, HCV treatment may play a role in HCV prevention given the potential to reduce onward transmission. Increased awareness of HCV and the available treatments among PWIDs will be critical. “Increasing screening is important, but we need to link that screening to care,” Andrew H. Talal, MD, MPH, from the University at Buffalo, New York, said. “It’s going to be important to, one, develop care in places where it generally has not been, such as opioid substitution therapy, but there is also no reason it has to be limited to methadone or buprenorphine programs — it could be any program where substance users gather.” Standard HCV testing requires detection of anti-HCV antibodies followed by confirmatory HCV RNA testing. Studies have shown, however, that a significant proportion of people who were positive for anti-HCV antibodies did not follow-up for HCV RNA testing. Reasons for drop-off included the number of separate visits required and a lack of knowledge from either the health care provider or patient who may not realize HCV RNA testing is necessary to confirm active infection. 

For more information: https://tinyurl.com/yaj9ub3h
 

Hep C World News - Week of April 8, 2018

Unrestricted access to DAAs nearly eliminates HCV in Australian prison   
 

Sydney, Australia - A program granting prison inmates with hepatitis C virus infection unrestricted access to direct-acting antiviral therapy nearly eliminated the virus at a correctional facility in Australia less than 2 years after its implementation, according to study findings published in Clinical Infectious Diseases. Open access to direct-acting antivirals (DAAs) was made available through the Pharmaceutical Benefits Scheme (PBS) — a component of the Australian Government’s National Medicines Policy that subsidizes the cost of certain medications. PBS expanded access to DAA therapy for people with HCV, including those in the correctional system, in March 2016, according to Sofia R. Bartlett, PhD, researcher in the Viral Hepatitis Clinical Research Program at The Kirby Institute, University of New South Wales in Sydney, Australia, and colleagues. HCV, they noted, is common in correctional facilities, with more than 10% of incarcerated people having the infection worldwide. HCV prevalence is even higher among people who inject drugs (PWID) who are incarcerated, they added. “The close relationship between injection drug use, incarceration and prevalence of blood-borne viruses makes correctional centers a crucial setting for enhanced DAA therapy access and broad prevention strategies,” Bartlett and colleagues wrote. “Population-level HCV elimination success will require effective HCV treatment and prevention programs among both PWID and people who are incarcerated.” After unrestricted access to DAA therapy was made available, the Lotus Glen Correctional Center (LGCC) in Queensland initiated a program implementing rapid treatment scale-up for inmates. Within the first 22 months of the program, the proportion of new inmates tested for HCV increased from 83% to 91%. Overall, 125 inmates who tested positive for HCV were offered treatment. Among them, 119 were prescribed interferon-free DAA for 8, 12 or 24 weeks. Bartlett and colleagues reported that 97% of patients with evaluable treatment outcomes had sustained virologic suppression. They estimated that HCV viremic point prevalence declined from 12.6% before the program, to 4.3% 1 year after implementation and 1.1% 22 months after implementation. More than 30 patients were lost to follow-up, and reinfections occurred in two LGCC inmates, one patient released from the facility and three transferred to another center, highlighting the risk for ongoing exposure and the need to improve communication liaisons between HCV treatment services in the correctional system and the community, according to the researchers.
The study demonstrates that correctional center-based DAA therapy services ... can provide favorable individual and facility population-level outcomes, Bartlett and colleagues concluded.
 

For more information: https://tinyurl.com/yafz4fwp
 

Hep C World News - Week of April 1, 2018

International HCV transmission in European MSM requires DAA scale-up  
 

Bern, Switzerland - In Switzerland, men who have sex with men from other countries likely account for about one-quarter acute hepatitis C infections, according to a study presented at the Conference on Retroviruses and Opportunistic Infections, also known as CROI. The researchers recommend joint European scale-up schemes for DAA therapy. “Scale-up of direct-acting antivirals, or DAA therapy, is happening all over Europe and independently in several countries, but Europe is highly interconnected and hepatitis C transmission knows no borders,” Luisa Salazar-Vizcaya, PhD, from the University Hospital of Bern, Switzerland, said in her presentation. “Mathematical models suggest that scale-up of DAAs has the potential to curve the epidemic of hepatitis C among HIV-positive MSM.” After establishing the likely geographic origin of infection, Salazar-Vizcaya and colleagues sequenced the HCV genotype 1a infections of 66 HIV-positive MSM patients to estimate the Swiss epidemic of HCV acquired by contact with MSM from abroad. Sampling dates ranged from June 2002 to May 2016. Based on reconstructed phylogenies, the researchers found that 97% of the study sequences were located in MSM clusters, 96% of which were found among five transmission clusters within Europe, and 90% of the sequences from acute infections in Swiss MSM were within transmission clusters. The estimated range of transmission between Swiss patients was from 38% to 76%; between German and Swiss patients ranged from 7% to 41%; and between other European regions and Swiss patients ranged from 0% to 28%. “We estimate that as much as 44% of our sequences were likely acquired by men not living in Switzerland,” Salazar-Vizcaya concluded. “This would suggest that international transmission networks may need to be taken into account, not only in planning but also in the assessment of the impact of DAA scale-up programs.”
 

For more information: https://tinyurl.com/ya2wbvan
 

Hep C World News - Week of March 25, 2018

Feds making it easier for doctors to prescribe heroin  
 

Ottawa, ON – The CBC has announced that the federal government is taking steps to make it easier for doctors to prescribe methadone and pharmaceutical grade heroin. Health Minister Ginette Petitpas Taylor will make the announcement at the Shepherds of Good Hope in Ottawa, a homeless shelter that offers programs for drug addicts. CBC News reports that it has obtained some of the details in advance. Right now, health care providers, from physicians to pharmacists, must apply for an exemption to prescribe, sell or provide methadone with approval from Health Canada. Now, the federal government will introduce regulatory amendments to lift this requirement and allow health care providers to administer methadone treatment without an exemption. Liberals say they'll back prescription heroin, drug checking services to fight opioid crisis NDP pushes Liberals to follow Trump, declare opioid crisis a national public health emergency The federal government is also planning to loosen restrictions around how to, and who can, prescribe pharmaceutical heroin, or diacetylmorphine, a drug often used to treat pain in a hospital setting. But it has also been known to help people with addictions who do not respond to other types of treatment, such as methadone and naloxone. Currently, diacetylmorphine can only be administered in a hospital. People with addictions who may need more than one dose a day find it difficult to make several trips to a hospital, especially if they are working. The federal government plans to introduce changes to the regulations that will allow heroin to be prescribed outside of a hospital, perhaps in treatment facilities or substance use disorder clinics. The changes will also allow nurse practitioners to prescribe the drug if they are allowed to under provincial laws.
 

For more information: http://www.cbc.ca/news/politics/ottawa-prescribe-heroin-methadone-1.4591058
 

Hep C World News - Week of March 18, 2018

Scale-up needed to reduce HCV prevalence among people who inject drugs  
 

Bristol, UK - Elimination of hepatitis C among people who inject drugs in Europe will require simultaneous scale-up of direct-acting antiviral treatment, needle and syringe programmes and opioid substitution therapy, and a re-think of attitudes to drug policy and harm reduction in Central Europe, according to a modelling study led by researchers from the University of Bristol. The study findings, published in advance online by the Journal of Hepatology, show that although increasing the number of people treated for hepatitis C may result in large reductions in prevalence in countries with low hepatitis C virus (HCV) prevalence, it will have little impact on new infections in most settings. In the European Union, 3.6 million people were estimated to have chronic HCV infection in 2016. Estimates of the number of people with hepatitis C who inject drugs are difficult to arrive at, due to lack of surveillance systems, lack of information about possible sources of exposure and uncertainty about the size of the current injecting population in European countries. The modelling study found that in most European settings, hepatitis C prevalence would fall by less than five per cent at current rates of treatment uptake among people who inject drugs. Treating five per cent of people who inject drugs each year would achieve a 99% reduction in prevalence in the Czech Republic and Slovenia, but a large reduction in prevalence would only come about in other countries if the coverage of opioid substitution therapy and needle and syringe programmes reached 80%. To achieve greater treatment coverage among people who inject drugs, improvements in screening will be needed to identify people with hepatitis C. A systematic review also published this month shows that prevalence is high in many countries among people who inject drugs and among prisoners. Systematic screening for prisoners and engagement in care, and provision of hepatitis C screening and treatment in accessible places for people who inject drugs, are two of the ways in which screening might be improved, say the authors. Several other innovative methods of harm reduction could have an impact on HCV transmission among people who inject drugs and in prisons. In Canada, federal prison authorities are considering the introduction of a needle and syringe programme for prisons, and also the provision of safe tattooing facilities, to reduce hepatitis C transmission. Needle and syringe programmes in prisons are still rare; Harm Reduction International found that only eight countries – including Germany, Spain and Switzerland – provided clean needles and syringes to inmates in 2016. Several cities in North America are pioneering the introduction of safe injecting sites, where people who inject drugs can go to inject drugs using sterile injecting equipment, with overdose treatment close at hand. These facilities offer a good way of engaging people who inject drugs in other harm reduction services, such as opioid substitution therapy, and can offer screening for hepatitis C too. One of the most important harm reduction interventions, opioid substitution therapy, is still not widely available in many countries and is strongly rejected as a harm reduction measure by governments and experts in some of the Eastern European countries with the highest prevalence of hepatitis C. Ukraine, however, is expanding its opioid substitution therapy programme and is now providing treatment to over 10,000 people. A recent Cochrane Collaboration systematic review found that opioid substitution therapy reduced the risk of HCV acquisition by 50% among people who inject drugs, while high coverage of opioid substitution therapy and needle and syringe programmes reduced the risk of HCV acquisition by 75%.
 

For more information: http://www.infohep.org/
 

Hep C World News - Week of March 11, 2018

Quebec and BC expand patient access to chronic Hepatitis C therapies
 

Mississauga, ON - Gilead Sciences Canada, Inc. recently announced that both Quebec and BC have expanded access to therapies that treat chronic hepatitis C virus infection. Patients in those provinces will now have greater access to treatment, regardless of the severity of disease (fibrosis level) to achieve a cure and improve their quality of life. Patients with chronic hepatitis C will no longer have to wait for their disease to progress before starting treatment. "Expanded access is an important milestone to achieve Canada's commitment to eliminating hepatitis C by 2030," said Kennet Brysting, General Manager of Gilead Canada. "Increasing hepatitis C treatment rates among patients and high-risk populations will help to reduce the burden of illness, the risk of transmission and the significant associated costs to the healthcare system." More patients now have access to a broad selection of therapies, including all those developed by Gilead Canada – EPCLUSA (velpatasvir/sofosbuvir), VOSEVI (voxilaprevir/velpatasvir/sofosbuvir), HARVONI (ledipasvir/sofosbuvir) and SOVALDI) (sofosbuvir). EPCLUSA is a publicly accessible treatment that can be used for patients with hepatitis C infection across all six genotypes, and VOSEVI is approved for use in patients who have failed on a previous direct-acting antiviral (DAA) treatment regimen.

For more information on the expanded access for hepatitis C therapies in these provinces:
Quebec: https://tinyurl.com/ybl2pzax
British Columbia: https://tinyurl.com/ybz62xzw  
 

Hep C World News - Week of March 4, 2018

Testing all adults for HCV cost-effective, improves outcomes    
 

Boston, MA - Newly published research suggests that expanding hepatitis C virus testing to everyone aged 18 years and older in the United States would likely be a cost-effective way to improve HCV outcomes. The strategy would also identify more than a quarter million more HCV cases than the current CDC-recommended strategy of screening baby boomers — those born between 1945 and 1965 — investigators wrote in Clinical Infectious Diseases. To estimate the cost-effectiveness of universal HCV screening, researcher Joshua A. Barocas, MD, an infectious disease physician at Massachusetts General Hospital and instructor of medicine at Harvard University Medical School, and colleagues used a simulation called the Hepatitis C Cost-Effectiveness (HEP-CE) model. “When we expanded testing, the results were compelling,” Barocas said in a press release, referring to the simulation. “Changing the current recommendations could have a major public health impact, improving the quality of life for young people with HCV, and reducing death rates.” HEP-CE simulates the course of the disease and its treatment in a hypothetical patient cohort with the same characteristics and epidemiology of the U.S. population, the researchers said. They applied the model to each of four HCV screening strategies:
 

• standard of care: one-time testing of everyone born between 1945 and 1965;
• ≥40 strategy: one-time testing of everyone aged 40 years or older;
• ≥30 strategy: one-time testing of everyone aged 30 years or older; and
• ≥18 strategy: one-time testing of everyone aged 18 years or older.

For all strategies, the researchers assumed risk-based testing of people who inject drugs. They found that each of the expanded testing strategies would identify more HCV cases, and result in the treatment and curing of more patients than standard of care. The greatest increases, however, were seen in the 18 strategy. Compared with standard of care, the 18 strategy would result in 256,000 more HCV diagnoses and 280,000 more cases cured, the researchers estimated. Additionally, 18 had the lowest cost per quality adjusted life year, at $28,000. Barocas and colleagues said their results could provide the basis for changes to the CDC’s HCV testing recommendations. “In addition to risk-based testing, routine, one-time HCV testing of persons 18 years and older is cost-effective, could lead to improved clinical outcomes and is likely to identify more persons with HCV than the current birth cohort recommendations,” they wrote. “These findings should be considered for future recommendation revisions.”
 

For more information: https://tinyurl.com/yapf9w7l
 

Hep C World News - Week of February 25, 2018

Access to Hep C therapies expand in Ontario

Toronto, ON - The Ontario Ministry of Health and Long-Term Care annonced the expansion of access to therapies that treat chronic hepatitis C virus infection under the Ontario Drug Benefit (ODB) Program. All eligible ODB recipients will have greater access to treatment, regardless of the severity of disease (fibrosis level), to achieve a cure and improve their quality of life. Patients with chronic hepatitis C will no longer have to wait for their disease to progress before starting treatment. The expansion will allow more patients to access a broad selection of therapies, including all those developed by Gilead Canada – EPCLUSA (velpatasvir/sofosbuvir), VOSEVI (voxilaprevir/velpatasvir/sofosbuvir), HARVONI® (ledipasvir/sofosbuvir) and SOVALDI® (sofosbuvir). EPCLUSA is a publicly accessible treatment that can be used for patients with hepatitis C infection across all six genotypes, and VOSEVI is approved for use in patients who have failed on a previous direct-acting antiviral (DAA) treatment regimen."Expanded access is an important milestone to achieve Canada's commitment to eliminating hepatitis C by 2030," said Kennet Brysting, General Manager of Gilead Canada. "Increasing hepatitis C treatment rates among patients and high-risk populations will help to reduce the burden of illness, the risk of transmission and the significant associated costs to the healthcare system." "Canada has committed to eliminating hepatitis C by 2030, and to accomplish this goal we need to significantly increase treatment rates," said Dr. Morris Sherman, Chairperson, Canadian Liver Foundation and hepatologist at Toronto General Hospital. "Treatment regimens are getting shorter, simpler and more widely effective across genotypes meaning that treatment is now easier for both patients and physicians to manage. "Currently, an estimated 44 per cent still remain undiagnosed, so increasing treatment rates also requires improving screening and diagnosis, which is why the Canadian Liver Foundation recommends that everyone in Canada born between 1945 and 1975 receive a one-time test for hepatitis C," added Dr. Sherman. "Treatment should be an option for everyone, regardless of disease severity, where they live in the province or their ability to pay. We're glad to see that the Ontario government is taking steps to make treatments accessible for more Ontarians with chronic hepatitis."
 

For more information: https://tinyurl.com/y8h42j5x     
 

Hep C World News - Week of February 18, 2018

HCV hospitalizations increasing among baby boomers
 

Boston, MA - Hospitalization for hepatitis C increased significantly between 2005 and 2014, especially among baby boomers, men, African-American and Hispanic patients, and patients with mental health and substance abuse disorders, according to data from a Healthcare Cost and Utilization Project statistical brief. “Baby boomers are aging and I think that's where we're seeing the greatest increase in hospitalizations,” Quyen Ngo-Metzger, MD, MPH, from the Harvard School of Medicine, Massachusetts, and lead study author, said. “What’s really interesting, though, is that if you look at both the young age groups, say 18 to 50 years, and the older age groups, both of those age groups showed large numbers of comorbid diseases.” Between 2005 and 2014, hospitalization for HCV was significantly more common than stays involving HCV plus hepatitis B, HIV or acute liver disease. Specifically, the researchers observed 342,400 HCV-only stays vs. 114,700 comorbid stays in 2005 and 509,700 HCV-only stays vs. 127,200 comorbid stays in 2014, for an increase of 48.9% vs. 10.9%. The rate for hospitalization among patients aged 52 years to 72 years, or the baby boomer generation, increased by 67.3% between 2005 and 2014, followed by 12.2% among patients aged 73 years or older. In contrast, the researchers observed a 14.9% decrease among patients aged 18 years to 51 years. “As the baby boomers are aging, hepatitis C is truly affecting them,” Ngo-Metzger said. “They had hepatitis C before, but now they're in this middle age group where you're seeing them hospitalized.” By demographic, other significant increases in hospitalization for HCV compared with hospitalization for other indications included men (61.5% vs. 47.9%), African-American patients (26.1% vs. 14%), Hispanic patients (10.1% vs. 7.9%), patients on Medicaid (38.1% vs. 17.4%), patients residing in low-income areas (40% vs. 28.8%) and patients residing in large central metropolitan areas (37.3% vs. 29.5%). Mental health disorders (71.6% vs. 44.3%) and (34.2% vs. 5.7%) were more common co-diagnoses among hospitalized patients with HCV than those without HCV. Among patients aged 18 years to 51 years, mental health disorder co-diagnosis was present in 78.4% of stays and substance use disorders in 53.5% of stays. Similarly, alcohol-related diagnosis unrelated to acute liver disease occurred more often in hospitalizations for HCV than for other indications (26% vs. 5.7%), especially in the younger 18 years to 51 years age group and the baby boomer group. The researchers observed that the most significant overlapping demographics were men, African-Americans and those on Medicaid within the baby boomer generation. “What I think is really important for hepatologists and others is that when these patients are coming into the hospital, it's not just about hepatitis C, that there are certainly these other mental health issues that need to be addressed as well,” Ngo-Metzger concluded.
 

For more information: https://tinyurl.com/yd574zqe
 

Hep C World News - Week of February 11, 2018

England seeks DAA price cuts to eliminate hep C by 2025  
 

London, UK - NHS England recently announced that it aims to eliminate hepatitis C by 2025 – if it can negotiate 'best value for money' deals with the pharmaceutical industry in a new round of tendering for direct-acting antivirals due to take place this month. NHS England already operates a 'no cure, no fee' deal with pharmaceutical companies. The money saved has allowed more people to be treated, including re-treatment of people with advanced or decompensated cirrhosis who were not cured by a previous course of direct-acting antiviral treatment. Approximately 160,000 people are estimated to have hepatitis C in England. To achieve elimination by 2025 NHS England will need to increase the number of people treated each year. The World Health Organization defines elimination of hepatitis C as a 65% reduction in HCV-related deaths and a 90% reduction in new infections by 2030, with 80% of eligible people treated by 2030. Achieving this target by 2025 implies either that more money will be made available, which is highly unlikely, or that NHS England is looking for a very substantial cut in the price of direct-acting antivirals. Public Health England says that approximately half of all people with hepatitis C may have been diagnosed in England and Wales, but according to Charles Gore, chief executive of the Hepatitis C Trust, “We have at least 100,000 people to find.” According to estimates released by the Polaris Observatory at the World Hepatitis Summit in November 2017, at least 10,000 people will need to be treated each year to achieve elimination by 2030. This number would need to rise to at least 16,000-17,000 a year to achieve elimination in 2025. But the Polaris Observatory warns that unless rates of diagnosis improve the number of people treated could fall to 5000 a year by 2020. NHS England plans to increase the number of people treated for hepatitis C to 13,000 in the year beginning April 2018, Professor Graham Foster announced earlier this month. A review of Operational Delivery Networks for hepatitis C treatment in England, published by the Hepatitis C Coalition in December 2017, indicated growing concern among healthcare professionals about how to identify new people in need of treatment. NHS England says that it wants to collaborate with the pharmaceutical industry to identify more people living with hepatitis C in need of treatment. If the treatment budget is not elastic, this implies that what NHS England hopes to secure is an agreement similar to the one obtained by the Australian government in 2016. The Australian deal committed the government to spend AUS$1 billion on direct-acting antivirals up to 2020, specified a heavily discounted price per treatment course, and placed a maximum cap on expenditure each year but no cap on the number of people who could be treated. The expenditure cap effectively allows free treatment for each additional patient once the annual budget is spent. As a result of the high enrolment on treatment, the deal has resulted in a cost per treatment of around £3100 to £3700 (5400 to 6500 euros) in 2016 in Australia, compared to a cost between £15,000 and £20,000 per treatment course in the United Kingdom. Calculations of the cost of production of generic versions of direct-acting antivirals presented at recent international scientific meetings show that a 12-week course of treatment with sofosbuvir/ledipasvir can be manufactured for $79, suggesting the scope for reductions in the cost of branded products. The Australian deal incentivizes new diagnoses and new treatment starts. A recent inquiry conducted in Scotland, led by the Hepatitis C Trust, shows that numerous parts of the health system will need to be encouraged to improve hepatitis C diagnosis, including substance misuse services, prison, general practitioners, pharmacies and accident and emergency departments.
 

For more information: https://tinyurl.com/y9m3f86o
 

Hep C World News - Week of February 4, 2018
 

Achieving SVR greatly reduces mortality risk  
 

Palo Alto, CA - Patients with hepatitis C without advanced liver disease who achieved sustained virologic response with direct-acting antiviral therapy had significantly reduced all-cause mortality rates compared with both treated patients who did not achieve SVR and untreated patients, according to recently published data reported by Helio.com. “These data strongly support a clinically significant benefit of DAA treatment in patients without clinically apparent advanced liver disease and establishes SVR as a pivotal outcome post DAA treatment specifically in relation to mortality,” Lisa I. Backus, MD, PhD, from the Palo Alto Department of Veterans Affairs, California, and colleagues wrote. “Increasing access to DAAs for all HCV-infected individuals should result in fewer deaths.” The study comprised 40,664 monoinfected patients with HCV genotype 1, 2 or 3 without advanced liver disease who received DAA therapy through Veterans Affairs. Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) was the most commonly prescribed DAA (65%). A multivariate analysis showed that SVR independently correlated with a significantly reduced risk for all-cause mortality, compared with both the untreated and the treated patients without SVR. Additionally, treated patients without SVR also had a reduced risk for all-cause mortality compared with untreated patients (HR = 0.74; 95% CI, 0.55-0.99). “The considerable number of HCV patients that have received DAA treatment in VA provided the power necessary to assess mortality that is not possible in smaller healthcare systems or in smaller clinical trials with limited follow-up,” the researchers wrote. “The present work demonstrates a substantial all-cause mortality benefit in patients without advanced liver disease — a population where demonstration of clinical benefit has been sparse, sparking controversy regarding the clinical urgency in treating this population.”

For more information: https://tinyurl.com/ycb7etvf
 

Hep C World News - Week of January 28, 2018

New Hep C drug combo approved for coverage
 

Ottawa, ON - The Canadian Agency for Drugs and Technologies in Health (CADTH) has posted their Common Drug Review recommendation for SOFOSBUVIR/VELPATASVIR/VOXILAPREVIR (VOSEVI).The detailed recommendation can be at this link: https://www.cadth.ca/sofosbuvir-velpatasvir-voxilaprevir. The recommendation is that VOSEVI be reimbursed for the treatment of adult patients with chronic hepatitis C virus (HCV) infection, without cirrhosis or with compensated cirrhosis, who have: genotype 1, 2, 3, 4, 5, or 6 infection and have previously been treated with an HCV regimen containing an NS5A inhibitor; OR genotype 1, 2, 3, or 4 infection and have been previously treated with an HCV regimen containing SOF without an NS5A inhibitor. To access these the patient must be under the care of a physician with experience in the diagnosis and management of HCV infection. It was also stipulated that drug plan cost for SOF/VEL/VOX should not exceed the drug plan cost for SOF/VEL.
 

For more information: https://www.cadth.ca/sofosbuvir-velpatasvir-voxilaprevir
 

Population-based estimate of hepatitis C virus prevalence in Ontario    
 

Hamilton, ON – A recent study looked at a population-based estimate of hepatitis C virus prevalence in Ontario. Hepatitis C virus (HCV) is the most burdensome infectious illness in Canada. Current screening strategies miss a significant proportion of cases, leaving many undiagnosed. Elevated HCV prevalence in those born between 1945 and 1965 has prompted calls for birth-cohort screening in this group. However, Canada lacks population-level data to support this recommendation. The researchers performed a serosurvey to obtain population-based HCV prevalence estimates in Ontario residents born between 1945–1974, to generate evidence for birth-cohort screening recommendations. The researchers tested anonymized residual sera in five-year age-sex bands from Ontario for anti-HCV antibody. They performed descriptive epidemiological analysis and used a logistic regression model to determine HCV risk-factors. Of 10,006 sera analyzed, 155 (1.55%, 95% confidence interval (CI) 1.32, 1.81) were positive for HCV antibody. Individuals born between 1950–1964 had a significantly higher combined prevalence of 1.92% (95% CI 1.56, 2.34) compared to 1.14% (95% CI 0.69, 1.77) (p = 0.04) for those born between 1970–1974. For males, comprising 107/155 (69.03%) of positive samples, the highest prevalence was 3.00% (95% CI 1.95, 4.39) for the 1960–1964 birth-cohort. For females, the highest prevalence was 1.56% (95% CI 0.83, 2.65) for those born between 1955–1959. Male sex was significantly associated with positive HCV serostatus. The authors concluded that HCV prevalence in Ontario is highest among those in this birth cohort, and higher than previous estimates. The prevalence estimates presented in their study provide important data to underpin birth-cohort screening recommendations. Authors of the study are: Shelly Bolotin, Jordan J. Feld, Gary Garber, William W. L. Wong, Fiona M. Guerra, Tony
Mazzulli

For more information: https://tinyurl.com/y6wunmgm
 

Hep C World News - Week of January 21, 2018

Increase in hepatitis C infections linked to worsening opioid crisis 
 

Atlanta, GA - New research from the Centers for Disease Control and Prevention (CDC) suggests that the recent steep increase in cases of acute hepatitis C virus infection is associated with increases in opioid injection. The study examines data from CDC’s hepatitis surveillance system and from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) national database that tracks admissions to substance use disorder treatment facilities in all 50 U.S. states. Across the nation, researchers found substantial, simultaneous increases in acute hepatitis C (133 percent) and admissions for opioid injection (93 percent) from 2004 to 2014. These increases were seen at not only the national level, but also when data were analyzed by state, by age, and by race and ethnicity. Taken together, the findings point to a close relationship between the two troubling trends. “Hepatitis C is a deadly, common, and often invisible result of America’s opioid crisis,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “By testing people who inject drugs for hepatitis C infection, treating those who test positive, and preventing new transmissions, we can mitigate some of the effects of the nation’s devastating opioid crisis and save lives.” The new analysis, published today in the American Journal of Public Health, builds upon earlier research identifying a similar regional trend in four Appalachian states that faced increasing rates of new hepatitis C virus infection. Hepatitis C is spread through infected blood, which can contain high levels of the virus in a single drop. This, combined with needle and injection equipment sharing behaviors among some people who inject drugs, is fueling infections among younger Americans. Rates of opioid injection—especially injection of prescription opioid pain relievers, as well as heroin—and acute hepatitis C virus infections increased most dramatically from 2004 to 2014 among younger Americans (ages 18-39). There were also sharp increases among whites and among women. Until recently, hepatitis C primarily affected older generations, but as the opioid crisis worsened, the virus gained a foothold among younger Americans. Most of the 3.5 million people in the United States already living with hepatitis C are baby boomers, born between 1945 and 1965, but the greatest increases in new infections are being seen in young people. And as infections increase among young women, so has the rate of hepatitis C among pregnant women—placing a new generation of Americans at risk. About 75 percent to 85 percent of newly infected people develop chronic hepatitis C virus infection. As there are few noticeable symptoms, many people are unaware of their infection until serious liver problems or other health complications arise. Hepatitis C is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. “We have the incredible opportunity to stop new infections and prevent people from dying of hepatitis C,” said John Ward, M.D., director of CDC’s Division of Viral Hepatitis. “With the right treatment and prevention efforts, we can eliminate hepatitis C as a public health threat within our lifetime – but to do so we must stop new infections at the source.”
 

For more information: https://tinyurl.com/y7gymld7
 

Hep C World News - Week of January 14, 2018

Best practice testing failed to ID hidden HCV infections   
 

Heerlen, the Netherlands -  A best practices strategy to improve detection of hepatitis B (HBV) and HCV virus infections had high uptake but failed to find undiagnosed HCV infections, a study found. The study, published online January 8 in the Annals of Family Medicine, is the first conducted in Europe to use a strategy that combines public health and primary care in birth cohort testing of hotspots with high HCV prevalence. "Because no active HCV infections were found in the identified hotspots, it is likely that the strategy taken would not be effective in other areas of the Netherlands and other low-prevalence countries," Jeanne Heil, MSc, from the Public Health Service, South Limburg, Heerlen, the Netherlands, and colleagues write. HCV and HBV infections are usually asymptomatic, which is why many people go undiagnosed until later in the infection, when liver damage can occur. In recent years, more effective treatments for HCV have been developed; however, better strategies for earlier identification of infections are needed so that people can take advantage of these improved therapies. Current recommendations advise universal testing for high-risk individuals, such as injection drug users, people with HIV, people who have received infected blood products, or those with a history of exposure or past risky behavior. However, some people do not remember or do not report such risks and go untested. Testing the general population may improve detection of hidden infections. One such strategy is birth cohort screening, which is currently recommended in the United States, where the HCV prevalence is 2%. That raises the question of whether this strategy works in countries with lower prevalence, such as the Netherlands, which has a prevalence of 0.1 to 0.4% nationwide. The researchers conducted a prospective cohort study that included 6743 individuals aged 40 to 70 years. Participants received care at 11 family practice clinics in two areas that are hotspots of HCV in the southern Netherlands. In these areas, HCV prevalence is 1%, and 66% of HCV infections are estimated to be undiagnosed. Family physicians personally invited patients to participate in testing, which was also advertised in waiting rooms and local newspapers. In addition, the regional public health service distributed letters and reminders about testing and organized testing at two community centers. Testing was free of charge and also took place in family practice clinics, at home, or at the hospital. Those who did not get tested received a reminder letter within 1 week. Participants were initially screened with anti-HCV and antihepatitis B core tests. Positive results were confirmed with additional testing. Those tested and those who declined testing received a questionnaire asking about sociodemographic information, HCV exposure risk factors (with the exception of sexual exposure risk), and reasons for participating. The strategy had high test uptake of 50.9% (n = 3434 patients), but did not detect any active or chronic HCV infections (0.00%; 95% confidence interval [CI], 0.00% - 0.11%). Positive test rates for anti-HCV, indicating past infection, were 0.20% (95% CI, 0.08% - 0.42%; n = 7). Rates for antihepatitis B core, indicating past HBV infection, were 4.14% (95% CI, 3.49% - 4.86%; n = 142). And rates for hepatitis B surface antigen, indicating active HBV infection, were 0.26% (95% CI, 0.12% - 0.50%; n = 9). Of those with active HBV infection, follow-up testing at 6 months showed that seven were undiagnosed, and six were chronic. The public health service traced 13 close contacts and vaccinated nine for HBV. To detect one positive case of past HCV infection, 491 people would need screening. To detect one positive case of past HBV infection, 24 people would need screening. And to detect one positive case of active HBV infection, 382 people would need screening. The authors mention several limitations, including the possibility of selection bias, particularly if those with HCV had low health literacy and chose not to participate. The study lacked information on many people who declined testing because 23% of these individuals did not respond to the questionnaire. That raises the possibility that results may not generalize to the larger Dutch population.
 

For more information: http://www.annfammed.org/content/16/1/21.abstract
 

Hep C World News - Week of January 7, 2018

Egypt leading country in eliminating HCV   
 

Cairo, Egypt - Health Minister Ahmed Emad el-Din said recently during a symposium, entitled “Toward Elimination of Viral Hepatitis”, that Egypt is a leading country in eliminating Hepatitis C as the ministry follows an efficient system to combat it. Emad el-Din added that the ministry has finished the waiting list, but comprehensive medical surveys should be conducted on citizens across Egypt. He pointed out that the ministry has already surveyed five million Egyptians. The Ministry of Health has taken a $75-million loan from the World Bank to improve the efficiency of the health sector. It is anticipated that Egypt will be hepatitis C free by 2022, announced Yehiya el-Shazly, president of the National Committee for Fighting Hepatitis C Virus (HCV) Infections, around a year ago. The following are the steps that were already taken by the Health Ministry. Seventy HCV governmental treatment centers and clinics have already been established across the country. The Ministry of Health provides a three-month treatment course for only LE 1,500 ($84.78). Two million citizens infected with HCV have already been treated, the Ministry of Health announced in December 2017. Member of the National Committee for Fighting Hepatitis C Virus (HCV), Yehiya el-Shazly, announced in February 2017 that the ministry has provided alternative treatment courses for 45,000 patients who went into remission. Several field inspection campaigns were carried out in nine Upper Egypt governorates throughout 2017 in order to understand the scope of the spread of HCV and to consequently provide necessary controls to curb its prevalence. The ministry also plans to conduct similar campaigns in the villages of the Nile Delta during the first three months of 2018. The ministry's national strategy also includes issuing certificates for patients who are proven to be fully recovered. The ministry is set to launch a massive campaign which will provide diagnoses for more than four million citizens.
 

For more information: https://tinyurl.com/ya9gbun4