HepCInfo Updates

HepCInfoUpdate 7.21  

Welcome to CATIE's HepCInfo Update 7.21 for October 31 to November 11, 2016. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

High cure rates for genotype 3 virus with new treatment

In a late-stage trial most participants with genotype 3 virus were cured with new hepatitis C medications glecaprevir and pibrentasvir, reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

People with genotype 3 virus are at higher risk of developing advanced liver injury and liver cancer than people with other viral genotypes.

Glecaprevir is a protease inhibitor and pibrentasvir is an NS5A inhibitor. They are combined in one pill that is taken once per day. This combination is not taken with ribavirin.

Participants took glecaprevir and pibrentasvir for either 12 weeks or 16 weeks.

Participants were divided into four treatment arms:

  1. Treatment experienced people without cirrhosis who received 12 weeks of treatment
  2. Treatment experienced people without cirrhosis who received 16 weeks of treatment
  3. Untreated people with cirrhosis who received 12 weeks of treatment
  4. Treatment experienced people with cirrhosis who received 16 weeks of treatment

For treatment experienced participants without cirrhosis, 16 weeks was more effective than 12 weeks of treatment, with cure rates of 96% versus 91%, respectively. In treatment arms 3 and 4 with people who had cirrhosis, the group who had never been treated before had a cure rate of 98% and the treatment experienced group had a cure rate of 96%.

According to the researchers,  “glecaprevir and pibrentasvir proved highly effective and well tolerated in perhaps the hardest-to-treat patient populations, treatment-experienced people and people with cirrhosis with genotype 3 infection who until now have had very limited options for achieving a hepatitis C cure.”

This treatment has also been tested in people with genotypes 1, 2, 4, 5 and 6 virus with high cure rates.

(aidsmap.com, November 2016)

B.C. study finds liver cancer risk reduced in people treated and cured of hepatitis C

In a large study that included all people treated for hepatitis C in British Columbia, the risk of liver cancer was reduced by 80% in people cured of hepatitis C (compared to those who were not cured by treatment), reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

The study included 8147 people who received an interferon based treatment between 1990 and 2013. Of this group, 57% were cured. All participants were followed for a mid-range of 5.6 years.

Compared to the participants without cirrhosis who were cured from treatment:

  • People with cirrhosis who were not cured from treatment were 19 times more likely to have liver cancer
  • People without cirrhosis who were not cured from treatment were 6.5 times more likely to have liver cancer
  • People with cirrhosis who were cured from treatment were six times more likely to have cancer

Having liver cancer was associated with cirrhosis, being older than 50 years of age, having genotype 3 virus versus genotype 1 virus, alcohol use and being male. Among those who were cured, only cirrhosis, being over the age of 50 and being male was associated with liver cancer.

According to the researchers, although curing hepatitis C greatly reduces the risk of liver cancer, it does not eliminate the risk entirely…underlying the importance of early diagnosis and treatment. (HIVandhepatitis.com, November 2016)

End-stage liver disease not reduced in people co-infected with hepatitis C and HIV despite better HIV treatments

Despite improvements in HIV care and treatment, the incidence of end-stage liver disease (ESLD) did not change for people with hepatitis C and HIV between 1996 and 2010, reported researchers in Clinical Infectious Diseases

While HIV treatment has improved life expectancy and health for people living with HIV it was unclear if it had resulted in a decrease in ESLD in people with hepatitis C and HIV.

Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), the researchers, which included researchers from Canada, compared the incidence of ESLD in three different periods in the development of HIV treatment: early (1996-2000), middle (2001-2005)and modern (2006-2010) and by hepatitis co-infection status.

There were a total of 34,119 individuals, 19% with hepatitis C co-infection, 5% with hepatitis B co-infection and 2% with triple infection (HIV, hepatitis C and hepatitis B).

During the study time period there were 380 ESLD events. The highest incidence of ESLD was observed among people with triple infection (11.57 per 1000 person-years), followed by HIV/hepatitis B coinfection (9.72 per 1000 person-years), HIV/hepatitis C coinfection (6.10 per 1000 person-years), and HIV mono-infection (1.27 per 1000 person-years). The proportion of people developing ESLD did not vary by calendar period, indicating that advances in HIV treatment had little impact on the incidence of ESLD.

According to the researchers, “The continued high incidence of ESLD despite modern [HIV treatment] underscores the urgent need to specifically address hepatitis C and hepatitis B infections in HIV-infected adults. Improved identification, staging, monitoring and treatment of co-infected persons should be prioritized." (HIVandhepatitis.com, October 2016)

Straight to the source for new science

Overview of harm reduction in prisons in seven European countries, Harm Reduction Journal, October 2016