HepCInfo Updates

HepCInfo Update 7.12  

Welcome to CATIE's HepCInfo Update 7.12 for June 25 to July 8, 2016. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

New pan-genotypic treatment approved in Canada

A new Hep C treatment called Epclusa has been approved in Canada. This combination is highly effective for treatment of all Hep C genotypes. It is a combination of two direct acting anti-viral medications (DAAs), sofosbuvir and velpatasvir.

The two medications are combined into one pill that is taken once per day for 12 weeks. People with severe liver injury (decompensated cirrhosis) take Epclusa with ribavirin.

Treatment was safe and generally well tolerated. The more common side effects were headache and fatigue. (catie.ca, July 2016, in English and French)

Portal hypertension reduced in people cured of Hep C

Hep C treatment with direct acting anti-viral medications (DAAs) can lead to a reduction in portal hypertension, reported researchers in the Journal of Hepatology.

In a severely damaged liver, scar tissue has replaced many liver cells, which makes it hard for blood to flow through the liver. This causes an increase in pressure (or hypertension) in the portal vein, which is the vein that supplies blood to the liver from the digestive system. Portal hypertension leads to a buildup of fluid in the abdomen (ascites) and bleeding veins in the esophagus and stomach.

The study included 104 people with Hep C and portal hypertension who were cured from Hep C treatment.

Portal hypertension was assessed using a measurement called hepatic venous pressure gradient (HVPG) at two times, before treatment (baseline) and after treatment. An HVPG reading of 6 mmHg is considered normal.

Being cured of Hep C significantly decreased portal pressure, regardless of how high portal pressure was at the beginning of treatment. Participants were grouped into different strata based on baseline portal pressure. Average changes in portal pressure after treatment  were as follows:

  • For the group with a portal pressure measurement of 6-9 mmHg at baseline, portal pressure fell from 7.37 to 5.11 mmHg (-2.26);
  • For the group with a portal pressure measurement of 10-15 mmHg at baseline, portal pressure fell from 12.2 to 8.91 (-3.29);
  • For the group with a greater than 16 mmHg at baseline: portal pressure fell from 19.4 to 17.1 mmHg (-2.3)

However, people with severe liver injury (Child-Pugh stage B) were less likely to have a HVPG decrease than people with less advanced liver injury (Child-Pugh stage A).  

"SVR to interferon-free therapies might ameliorate portal hypertension across all baseline HVPG strata," the study authors concluded. (HIVandhepatitis.com, June 2016, in English)

Health Canada allowing immediate access to naloxone nasal spray

The Minister of Health has signed an Interim Order to temporarily allow naloxone in nasal spray form to be imported from the U.S. and sold in Canada. Naloxone blocks the effect of opioids on the body and is used to treat opioid overdose.

There has been an increase in overdoses in Canada due to the increased distribution of a powerful opioid called fentanyl.  For example, Alberta recorded more than 270 overdose deaths related to fentanyl last year. Fentanyl may be sold as another less powerful opiate, such as Oxycontin.

Until now, only the injectable form of the drug has been available in Canada. The Interim Order allows the nasal spray, which has been approved by the U.S. Food and Drug Administration, to be temporarily sold in Canada. (globalnews.ca, July 2016, in English)

Straight to the source for new science

CIHR Canadian HIV trials network coinfection and concurrent diseases core research group: 2016 updated Canadian HIV/Hepatitis C adult guidelines for management and treatment, Canadian Journal of Infectious Diseases and Medical Microbiology, 2016, in English

Diabetes and cirrhosis are risk factors for hepatocellular carcinoma after successful treatment of chronic hepatitis C, Clinical Infectious Diseases, June 2016