HepCInfo Update 8.6
Welcome to CATIE's HepCInfo Update 8.6 for March 4 to March 17, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.
New and noteworthy
Acute cases of hepatitis C in HIV-positive gay and bisexual men in a large Dutch study decreased by approximately half between 2014 and 2016, reported researchers at the Conference on Retroviruses and Opportunistic Infections.
The researchers looked at data from 17 HIV treatment centres in the Netherlands from 2014 to 2016. During this time period direct-acting antiviral hepatitis C medications (DAAs) were available in the Netherlands without restrictions. This data accounted for 80% of Dutch HIV-positive gay and bisexual men in care.
In 2014, there were 93 people diagnosed with an acute hepatitis C infection (incidence rate of 11.2 per 1000 person years). In 2016, there were 49 cases of acute hepatitis C (incidence rate of 5.5 per 1000 person years). The annual acute hepatitis C incidence rate fell from 1.1% to 0.5% per year, a 51% reduction.
The researchers noted a 41% increase in new syphilis cases during the study time period so they didn’t think the reduction in acute hepatitis C cases was due to changes in sexual behaviours. According to the researchers, “unrestricted access and use of DAA for the treatment of chronic and acute hepatitis C is the most likely explanation.” (HIVandhepatitis.com, February 2017)
Older adults with a past or current hepatitis C infection are at higher risk of liver and non-liver cancers than people without hepatitis C, reported researchers in Cancer.
The researchers analyzed data from the Surveillance, Epidemiology and End Results (SEER) study, an American national cancer research program. This study included 1.6 million people 66 years and older with cancer who received cancer care between 1993 and 2011 and 200 000 people without cancer.
The prevalence of hepatitis C was slightly higher in those with cancer than the control group (0.7% vs 0.5%).
People with a past or current hepatitis C infection were more likely to have the following cancers than the control group:
- 31.5 times more likely to have liver cancer
- 3.40 times more likely to have cancer of the ducts that carry bile inside of the liver
- 1.97 times more likely to have anal cancer
- 1.90 times more likely to have cancer of the ducts that carry bile outside of the liver
- 1.57 times more likely to have a cancer that affects the immune system (diffuse large B-cell lymphoma)
- 1.56 times more likely to have a cancer that affects blood cell production in the bone marrow (Myelodysplastic syndrome)
- 1.56 times more likely to have a type of skin cancer (non-melanoma non-epithelial)
- 1.23 times more likely to have cancer of the pancreas
The researchers estimated that eliminating hepatitis C would reduce the risk of liver cancer by 16%. However, eliminating hepatitis C would only have a modest impact on reducing other cancers such as cancers of the bile duct and pancreas.
According to the researchers, “studies are needed to strengthen the evidence linking hepatitis C infection to these cancers and to further elucidate biological mechanisms.”(hivandhepatitis.com, February 2017)
People co-infected with hepatitis C and HIV who also have severe liver injury had high cure rates with direct-acting antiviral (DAA) treatments, reported Spanish researchers at the Conference on Retroviruses and Opportunistic Infections.
Participants (170) were from 13 Spanish clinics who started DAA treatment during 2015. About three-quarters of participants were men and the average age was 51 years. All participants were diagnosed with cirrhosis. Most people (75%) had a functional but severely damaged liver (compensated cirrhosis).
All participants were taking HIV treatment and 89% had an undetectable HIV viral load.
Participants were most commonly treated with one of the following medications for 12 or 24 weeks:
- Harvoni (15%)
- Harvoni and ribavirin (25%)
- Sofosbuvir, simeprevir and ribavirin (20%)
- Sofosbuvir, daclatasvir and ribavirin (15%)
Overall, 98% of people who had never been treated and 89% of treatment-experienced participants were cured from treatment. Treatment was generally safe and well tolerated. On average, liver health improved for participants after treatment (liver stiffness decreased by an average of 5.6 kPa).
DAAs are becoming increasingly effective. With older treatments people with severe liver injury and people co-infected with hepatitis C and HIV were generally less likely to be cured from treatment. With new treatments the cure rates are promising for people with both HIV/hepatitis coinfection and advanced liver disease. (infohep.org, March 2017)
Straight to the source for new science
Social capital strategies to enhance hepatitis C treatment awareness and uptake among men in prison, Journal of Viral Hepatitis, February 2017
Mortality rates in patients with chronic hepatitis C and cirrhosis compared with the general population: A Danish cohort study, The Journal of Infectious Diseases, February 2017