HepCInfo Updates

HepCInfo Update 8.11  

Welcome to CATIE's HepCInfo Update 8.11 for May 13 to May 26, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

New hepatitis C treatment cures 99% of people with cirrhosis

An experimental hepatitis C treatment of 12 weeks of glecaprevir and pibrentasvir cured 99% of participants, reported researchers at the International Liver Congress.

Glecaprevir is a protease inhibitor and pibrentasvir is an NS5A inhibitor. They are combined into one pill that is taken once per day.

Of the 146 people in the study the majority (59.6%) had genotype 1 virus, 23% had genotype 2 virus, 11% had genotype 4 virus, 1.4% had genotype 5 virus and 5% had genotype 6 virus. This treatment was tested in people with genotype 3 virus in another study.

Three-quarters of participants had never been treated before. A majority of participants were male (62%), white (82%) and the mid-range in age was 60 years.

Treatment was safe and well tolerated. The most common side effects were headache (14%), fatigue (19%) and itching (10%). In most cases, these side effects were mild. (HIVandhepatitis.com, April 2017)

Hepatitis C reinfection uncommon among people on OST after being cured with DAAs

Only a small number of people who use drugs and enrolled in opioid substitution therapy (OST) were reinfected with hepatitis C after being cured through treatment with Zepatier, reported researchers at the 25th Harm Reduction International Conference.

A late stage trial of Zepatier which consists of two direct-acting antiviral (DAA) medications, grazoprevir and elbasvir, enrolled people who had been taking OST for a least three months. Participants were screened regularly for drug use but were not disqualified from the study if they used drugs.

The study had 301 participants with either genotype 1, 4 or 6 virus who had not previously been treated. Over half of participants used street drugs during the study.

In the first phase of the study, participants received Zepatier for 12 weeks and 91% were cured.

In the second phase, two-thirds of the study participants (199 people) agreed to be followed for three years. They had clinic visits every six months to test for hepatitis C. If this test was positive the genetic material of the virus was tested to see if this virus was different from the virus they previously had.

Reinfection rates were low. Five participants were reinfected by 12 weeks of follow up, one more person became reinfected at week 24 and two more at six months for a total of eight reinfections (4.0 per 100 person years).

Drug use stayed approximately the same over the three-year follow up period. With regard to injection drug use, 21% said they had injected drugs in the past month, while 25% said they had done so in the last six months.

According to the researchers, “these results support advocacy efforts to expand hepatitis C treatment for people who inject drugs.” (hivandhepatitis.com, May 2017)

Use of albumin reduces the complications of decompensated cirrhosis

Long-term administration of human albumin, a protein that helps maintain fluid balance in the body, was associated with fewer serious complications and hospitalizations and longer survival for people with decompensated liver disease, reported researchers at the International Liver Congress.

Decompensated cirrhosis occurs when the liver can no longer carry out its functions due to the accumulation of scar tissue and the blockage of blood flow. Complications of decompensation include ascites (build up of fluid in abdominal cavity), bleeding veins in the esophagus and hepatic encephalopathy (confusion, forgetfulness and other changes in brain function).

This study enrolled 440 participants with advanced cirrhosis from 30 centres in Italy.

Participants were randomly assigned to receive standard medical treatment (diuretics) or standard treatment plus human albumin (40 grams twice weekly for two weeks, then reduced to once weekly). They were followed for 18 months.

Participants who received albumin had a higher survival rate than those who did not. After 18 months, 78% of people who used albumin were still alive compared to 66% of those with standard therapy alone.

People who took albumin were also less likely to need paracentesis (removal of fluid from the abdomen using a needle). After 18 months, 38% of people in the albumin arm underwent paracentesis at least once, compared to 66% in the standard treatment arm.

After 18 months, only 25% or people in the albumin arm had ascites versus 48% in the standard treatment arm.

Hospitalizations were also reduced in the arm receiving albumin, with 35% fewer hospitalizations and 45% less days spent in the hospital compared to the standard treatment arm.  

People in the albumin arm were also less likely to develop other complications of cirrhosis, such as, bacterial infections, hepatic encephalopathy, bleeding veins in the esophagus and kidney problems, including kidney failure. (HIVandhepatitis.com, May 2017)

Straight to the source for new science

Continuum of care for hepatitis C virus among patients diagnosed in the emergency department setting, Clinical Infectious Diseases, February 2017

Education and equipment for people who smoke crack cocaine in Canada: progress and limits, Harm Reduction Journal, May 2017