HepCInfo Updates

HepCInfo Update 8.10 

Welcome to CATIE's HepCInfo Update 8.10 for April 29 to May 12, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

New DAA treatment not linked to higher liver cancer risk compared to interferon treatment

People treated for hepatitis C with new direct-acting antivirals (DAAs) do not appear to have a higher risk of developing liver cancer compared to people treated with interferon, an older hepatitis C medication, reported authors of a systematic review and meta-analysis at the International Liver Congress, a conference hosted by the European Association for the Study of the Liver (EASL).

Three previous studies have suggested a link between DAA treatment and developing liver cancer.

This analysis included nearly 14,000 participants across 41 studies of initial or recurring liver cancer (hepatocellular carcinoma or HCC).

Participants treated with DAAs differed in some important ways from those treated in the interferon era. People treated with DAAs who initially developed liver cancer were older on average than those treated with interferon (60 vs 52 years). People treated with DAAs also had more advanced liver disease. All participants in studies of initial liver cancer occurrence who were treated with interferon had a milder level of cirrhosis (Child-Pugh A), while about 30% of those treated with DAAs had more severe cirrhosis or decompensation (Child-Pugh B or C).

Liver cancer is more likely to occur in older people and people with advanced liver damage.

After accounting for these factors, no increased risk of liver cancer with DAAs was found (the adjusted relative risk of DAA versus interferon treatment was 0.75 for initial HCC occurrence and 0.62 for HCC recurrence). (infohep.org, April 2017)

Hepatitis C treatment allows one in four to come off liver transplant list

About one in four people with hepatitis C and decompensated cirrhosis came off the liver transplant waiting list in Europe after being cured by treatment with DAAs, reported researchers at the International Liver Congress.

The study was undertaken as a multi-centre cohort study through the European Liver and Intestine Transplant Association (ELITA) which includes liver transplant clinics in Italy, Germany, Austria, France and Spain.

It has been unclear whether curing people with severe liver injury (decompensation) would significantly improve their health or rather it would mean they would improve enough to no longer qualify for a transplant, and thus be taken off the transplant list, but would still be very sick. 

The study included 142 people on transplant waiting lists with hepatitis C and decompensated cirrhosis who were treated with direct-acting antivirals between February 2014 and June 2015. Participants received treatment with sofosbuvir and ribavirin, sofosbuvir and daclatasvir or Harvoni.

Just under a quarter (34 people) were taken off the transplant list. These participants were followed for a median of 58 weeks.

A minority of participants had negative outcomes, including two people who experienced improvement but later decompensated, one who had a liver transplant, one who required treatment for accumulation of abdominal fluid (ascites, a symptom of decompensation) and one who died of liver cancer.

Most people who were removed from the transplant list experienced significant improvements in liver-related outcomes. MELD scores, which are used to assess the severity of injury to the liver with higher numbers indicating more serious damage, declined from a mid-range of 14 at baseline to nine. The percentage of people with ascites, decreased from 81.6% at baseline to 23.7% at the last follow up visit. Hepatic encephalopathy, a symptom of decompensation in which brain functioning is affected, also decreased (29% to 2.9%). (infohep.org, April 2017)

High cure rates with Harvoni in people with hepatitis B and C

All participants in a clinical trial of Harvoni in people co-infected with hepatitis B (HBV) and C were cured, reported researchers at the International Liver Congress.

This is the first time a direct-acting antiviral (DAA) combination has been tested in people co-infected with hepatitis B and C.

All 111 participants in the Taiwan-based study were cured of hepatitis C from a 12-week treatment of Harvoni. Harvoni is a combination of two DAAs, sofosbuvir and ledipasvir. Participants had either genotype 1, 2 or 3 virus.

Over half of the participants experienced side effects but they were mostly mild. The most common side effects were fatigue, upper respiratory tract infection and headache. A majority (63%) of the participants experienced Hepatitis B DNA reactivation but in almost all cases this was not clinically significant. Two participants who had HBV reactivation started HBV treatment according to Taiwanese treatment guidelines.

HBV DNA reactivation was associated with high baseline HBV DNA and a high amount of a marker in the blood that indicate liver problems (ALT). (Healio.com, May 2017)

Straight to the source for new science

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis, Harm Reduction Journal, May 2017