HepCInfo Updates

HepCInfo Update 8.9  

Welcome to CATIE's HepCInfo Update 8.9 for April 15 to April 28, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

First Canadian guidelines on hepatitis C testing recommend against population-wide screening

The Canadian Taskforce for Preventative Health Care (CTPHC) recently released the country’s first recommendations for hepatitis C screening. The guidelines, which apply to the general adult population, do not recommend population-wide screening for older adults, instead they recommend continuing to screen people at higher risk of infection, such as people with a history of injection drug use.

In an interview with the Globe & Mail, Dr. Roland Grad, who led the guidelines working group stated the taskforce decided against the birth-cohort recommendation for two reasons:

  • The lack of high quality evidence for a birth cohort screening
  • The prospect that screening would lead to a demand for treatment that would be costly

The Canadian Liver Foundation (CLF) and several Canadian liver experts criticised the recommendations. The CLF has been urging people born between 1945 and 1975 to be screened for hepatitis C.  The U.S Centre for Disease Control and Prevention (CDC) has a similar recommendation.

The CTPHC has said it may reconsider its recommendations if more provinces and territories expand access to hepatitis C medications.  (canadiantaskforce.ca, April 2017)

Nova Scotia expands access to hepatitis C medications

Nova Scotia has expanded coverage for six hepatitis C medications as of May 1, 2017. New hepatitis C drugs added to the Nova Scotia formulary are asunaprevir, daclatasvir, Epclusa and Zepatier. In addition, coverage is expanding for Harvoni and sofosbuvir.  Holkira Pak will no longer be covered under the formulary except for people who started the medication prior to May 1, 2017.

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.

So far B.C, Alberta, Saskatchewan, Quebec and Ontario have made similar changes to their provincial formularies to expand access to hepatitis C medications. (novascotia.ca, May 2017)

Heterosexual couples who inject drugs together try to prevent harms from injecting through negotiated safety

Heterosexual couples who used drugs together tried to avoid sharing their equipment but when they did they adopted strategies to minimize the risk of hepatitis C transmission, reported researchers in Health and Social Science & Medicine.

All participants were recruited through drug services in two cities in Australia. The participants included 34 couples and 12 individuals.

Twenty-nine couples reported sometimes sharing injection equipment within their partnership.

Participants described their relationships as a refuge against the outside world. When talking about using drugs with their partners, many participants emphasised trust, honesty, safety and security. Almost all participants described codes of conduct they had negotiated with their partner around using drugs with other people. Following these rules was key to maintaining trust and intimacy within the relationship.

Almost all participants said that while they had shared needles with their partner, they would not with anyone else. By doing this, many attempted to reduce the risk of passing viruses, based on their shared knowledge of each other’s hepatitis C status.

“Every now and then when we have been stuck and we’ve only got one fit [needle] between us… [He] will make sure that I use it… then he’ll rinse it and use it… Because he has [hepatitis C] and I don’t… And he wants to keep it like that.”

The researchers described such strategies as negotiated safety.

“Failing to recognise the unique issues that face couples who inject drugs, and disregarding their partnerships, means missed opportunities for understanding decision making around injecting drug use and hepatitis C prevention,” say the researchers. The researchers suggested that there could be a potential for couples-orientated programmes for detoxification, opioid substitution therapy and hepatitis C treatment. (infohep.org, April 2017)

Straight to the source for new science

Recommendations on hepatitis C screening for adults, Canadian Medical Association Journal, April 2017

Risk of cirrhosis-related complications in patients with advanced fibrosis following hepatitis C virus eradication, Journal of Hepatology, March 2017