HepCInfo Updates

HepCInfo Update 8.12  

Welcome to CATIE's HepCInfo Update 8.12 for May 27 to June 9, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Six questions identify HIV-positive men who need testing for acute hepatitis C

Six questions can identify HIV-positive gay men who are at risk of having acute (recent) hepatitis C infection and who would benefit from further testing, according to researchers in Eurosurveillance.

The six questions are part of a risk score based on self-reported behaviours, specifically:

  • Condomless receptive anal intercourse in the past six months (a positive response is given a score of 1.1)
  • Sharing of sex toys in the past six months (score 1.2)
  • Fisting without gloves in the past six months (score 0.9)
  • Injecting drug use in the past 12 months (score 1.4)
  • Sharing of straws to snort drugs in the past 12 months (score 1.0)
  • An ulcerative sexually transmitted infection, such as syphilis, in the past 12 months (score 1.4)

A man scoring a sum total of 2.0 or more would be recommended for acute hepatitis C testing.

The risk score was developed from analysis of data from 213 participants in the Dutch MOSAIC study. This is an observational cohort, enrolling HIV-positive gay men with acute hepatitis C and HIV-positive gay men without a history of hepatitis, who act as control participants.

The risk score was validated with data from three other studies, a Belgian study (142 men), an English study (190 men) and another Dutch study (248 men).

The risk score can successfully identify HIV-positive men who have sex with men at risk for acute hepatitis C infection, concluded the researchers. (aidsmap.com, June 2017)

Triple combination cures most people who had previously tried DAA treatment but were not cured

Almost all people with genotype 1 virus who had previously been treated with direct-acting antiviral (DAA) treatment were cured using an experimental triple combination, reported researchers at the International Liver Congress.

Currently, few treatment options exist for people who have previously been treated with DAAs but were not cured.

The triple combination consisted of grazoprevir (a protease inhibitor), uprifosbuvir (an NS5B polymerase inhibitor) and ruzasvir (an NS5A inhibitor). This combination was taken once daily with ribavirin for 16 weeks or for 24 weeks without ribavirin.

They study included 94 participants. Most were men (80%) and the mid-range in age was 60 years. More than 40% had cirrhosis.  The hepatitis C virus of most participants had at least one type of DAA resistance.

The cure rates were 98% in the 16-week arm and 100% in the 24-week arm. The presence of cirrhosis and DAA resistance did not effect cure rates.

The most common side effects were fatigue, headache, diarrhea, rash and itching. These side effects were mostly mild or moderate.

 Grazoprevir/ruzasvir/uprifosbuvir with or without ribavirin “was highly effective in genotype 1 participants who previously failed an NS5A inhibitor-containing direct-acting antiviral regimen,” the researchers concluded. (infohep.org, May 2017)

Experimental combination cures 97% of people with genotype 3 virus

A two-drug experimental combination cured 97% of participants with genotype 3 virus, reported researchers at the International Liver Congress.

Historically, people with genotype 3 virus have had many fewer effective treatment options than people with genotype 1 virus.

The combination consisted of glecaprevir (a protease inhibitor) and pibrentasvir (an NS5A inhibitor). Participants took this combination for 8 weeks or 12 weeks. There was also a comparison arm where people took daclatasvir and sofosbuvir for 12 weeks. 

The 12-week glecaprevir and pibrentasvir (G/P) treatment was non-inferior to the 12-week daclatasvir and sofosbuvir arm (95% vs 97% were cured). The 8-week G/P arm was also non-inferior to the 12-week daclatasvir and sofosbuvir arm, however there was a slightly higher rate of viral relapse after treatment.

A clinical trial that tests for non-inferiority examines if a new treatment is as effective as another treatment. The new treatment must be as effective within a small margin determined before the trial.

Overall, 97% of participants receiving glecaprevir and pibrentasvir in the two study arms were cured.

The most common side effects include nausea, fatigue and headache, but all were mild. (infohep.org, April 2017)

Straight to the source for new science

Social-structural factors influencing periods of injection cessation among marginalized youth who inject drugs in Vancouver, Canada: an ethno-epidemiological study, Harm Reduction Journal, June 2017

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