HepCInfo Update 8.7
Welcome to CATIE's HepCInfo Update 8.7 for March 18 to March 31, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.
New and noteworthy
Saskatchewan is offering expanded access to six hepatitis C medications as of April 1, 2017. New hepatitis C drugs added to the Saskatchewan formulary are asunaprevir, daclatasvir, Epclusa and Zepatier. In addition, coverage is expanding for Harvoni and sofosbuvir, listed in 2015.
An estimated 12,000 people in Saskatchewan live with hepatitis C.
In February of 2017, the pan-Canadian Pharmaceutical Alliance (pCPA), the body that represents provinces and territories in drug pricing agreements negotiated an agreement with several pharmaceutical companies to lower prices for six hepatitis C medications.
After a pCPA deal is reached each province and territory decides how it will implement the changes to its formulary. (saskatchewan.ca, March 2017)
A large study has found that even people with a moderate level of liver injury have an increased risk of mortality compared with people with low or no liver injury, reported researchers in Clinical Infectious Diseases.
Participants (964) were part of a larger study of people with a history of injection drug use in Baltimore, U.S. called the ALIVE study. Each participant in this study had hepatitis C. The mid-range of the age of participants was 49 years. Most participants were male (72%) and 87% were African American. Over half were currently using injection drugs. A third of participants also had HIV, 52% of whom were taking HIV treatment.
Participants were followed for a mid-range of 5.9 years (between 2006 and 2014). Liver stiffness measurements were taken twice each year using Fibroscan.
During the study there were 155 deaths (giving a mortality rate of 3.06 deaths per 100 person-years). The mortality rate was highest among people with advanced liver injury (6.21 deaths per 100 person-years), but was still higher in people with moderate liver injury (3.59 deaths per 100 person years) than in participants with no or mild liver injury (2.21 deaths per 100 person years).
Even after adjusting for several factors, mortality remained elevated among people with moderate liver injury (adjusted hazard ratio 1.66).
According to the researchers, “Although increased mortality was evident among individuals with severe fibrosis/cirrhosis, we observed some increased risk of mortality, even among those with moderate fibrosis...these data support the [American] guidelines for treatment of all persons with chronic hepatitis C infection and not support withholding treatment from those with mild disease.”” (infohep.org, March 2017)
HepCInfo Update 8.6 reported a story about the dramatic decrease in acute hepatitis C cases among HIV-positive gay and bisexual men. This related story reports on the rollout of Hep C treatment among this population in the Netherlands.
About three-quarters of gay and bisexual men co-infected with HIV and hepatitis C have been cured of hepatitis C or are currently being treated for the virus, reported researchers of a large Dutch study at the Conference on Retroviruses and Opportunistic Infections.
As of November 2015, people co-infected with HIV and hepatitis C in the Netherlands can access direct-acting antiviral hepatitis C medication (DAAs) without restriction.
The researchers analyzed data from the ATHENA cohort, a study of almost all (98%) HIV-positive Dutch people in care since 1998. Of the approximately 22,000 participants who were screened for hepatitis C, 2,242 were co-infected with hepatitis C and HIV. Of these 1,420 remained in care.
The majority of these people were men (89%), with an average age of 49 years old. More than 90% were taking HIV treatment and had an undetectable viral load. Two-thirds of participants were gay or bisexual men.
As of January 2017, 82% of all co-infected participants had started hepatitis C treatment and 65% had been cured or were still being treated. Among people who were treated the cure rate was very high (98%).
About three-quarters (76%) of gay and bisexual men had been cured or were still on treatment compared to 45% of other groups. People with a history of injection drug use, people with uncontrolled HIV and women, particularly African women, were less likely to access hepatitis C treatment. (HIVandhepatitis.com, February 2017)
Straight to the source for new science
Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study, Harm Reduction Journal, February 2017
Attending the 25th Harm Reduction International Conference in Montréal, QC and want to learn more about hepatitis C?
Come to the one day Hepatitis C Satellite Symposium on May 13, 2017. You’ll hear from international experts about linkages to HCV prevention and care, develop practical skills with which to treat HCV in drug and alcohol settings and discuss how to improve HCV care for people who inject drugs. For more information click here and to register click here