HepCInfo Updates

HepCInfoUpdate 7.23 

Welcome to CATIE's HepCInfo Update 7.23 for November 26 to December 9, 2016. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Non-adherence key factor in not being cured with Harvoni

Non-adherence was the strongest risk factor for people not being cured with Harvoni (sofosbuvir/ledipasvir), reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

The researchers compared 43 participants from a medical clinic in New York City who had experienced viral relapse after treatment with Harvoni to 101 participants from the same clinic who were cured from treatment.

Of the people that were not cured from Harvoni, the average age of participants was 59 years. The majority were African American (54%), 26% were Hispanic and 20% were white.

Non-adherence (defined as missing at least seven doses of Harvoni) was the factor most strongly connected to treatment failure. The participants stated the main reasons for non-adherence were not taking medication as prescribed (5 people) and hospitalization (3 people).

The only significant difference between people who adhered to treatment and those who didn’t was the number of clinic visits. People who were non-adherent had a modestly higher average number of clinic visits (3.9) than people who were adherent (2.6 visits).

The researchers concluded that their findings "underscore the need for providers to clearly communicate dosing information and to ensure that patients have access to an uninterrupted supply of medication." They suggested that pre-treatment adherence counseling and a pill bottle monitoring system may also improve cure rates. (HIVandhepatitis.com, November 2016)

Portal hypertension may improve after hepatitis C cure

Curing hepatitis C can moderately reduce portal hypertension but has less of an impact in people with severe liver injury (cirrhosis), reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

Portal hypertension is high blood pressure in the portal vein supplying the liver. It is caused by scarring in the liver which restricts blood flow through the liver. If it persists it can lead to gastrointestinal bleeding.

This multi-centre trial with 198 participants was led by a hospital clinic in Barcelona, Spain. All participants had liver cirrhosis and clinically significant portal hypertension (CSHP).

Participants received a hepatic venous pressure gradient (HVPG) assessment and liver stiffness measurement prior to treatment and at 24 weeks post-treatment.

Overall, HVPG decreased significantly after participants were cured. While all people had CSHP before treatment, 83% still had it 24 weeks after treatment. A clinically relevant decrease (at least 10%) in portal hypertension was seen in 54% of participants; 34% had a decrease of 20% or more.

Participants with F3 or lower levels of fibrosis at baseline were less likely to have CSHP 24 weeks after treatment compared to participants with F4 level of liver injury (48% compared to 92%).  (HIVandhepatitis.com, November 2016)

Six weeks of Harvoni effective in acute hepatitis C with genotype 1 virus

In a small pilot study, six weeks of Harvoni (sofosbuvir/ledipasvir) cured 100% of participants with acute hepatitis C and genotype 1 virus, reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

This study included 20 participants from ten centres in Germany. The majority (60%) were men and their average age was 46 years. Just over half (55%) had genotype 1a virus, which is considered harder to treat, and the rest had genotype 1b virus. Participants were all mono-infected with hepatitis C. People with HIV and hepatitis C co-infection were excluded from the study.

All 20 participants were cured, although one person was lost to follow up.

Treatment was generally safe and well tolerated.

The researchers concluded that "short treatment of only six weeks was highly effective with an SVR12 rate of 100% in acute genotype 1 mono-infected patients,"

Given that more than half of study participants achieved undetectable viral load by week four of treatment, the researchers suggested that even shorter durations could be studied. (HIVandhepatitis.com, November 2016)

Straight to the source for new science

Uptake of hepatitis C screening, characteristics of patients tested, and intervention costs in the BEST-C study, Hepatology, November 2016