HepCInfo Updates

HepCInfo Update 8.13 

Welcome to CATIE's HepCInfo Update 8.13 for June 10 to June 23, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Electronic hepatitis C screening intervention improves testing and linkage to care for older adults

A clinical decision support tool connected to electronic health records significantly increased hepatitis C screening, follow up testing and linkage to care among older adults, reported researchers in Open Forum Infectious Disease.

The U.S. Centers for Disease Control and Prevention and the U.S. Preventative Services Task Force have recommended one-time hepatitis C screening for adults born between 1945 and 1965, however efforts to test and link people to care have had mixed success.

The support tool was implemented in the UCLA health system in August of 2015. The tool consisted of a reminder in outpatient electronic health records that patients born between 1945 and 1965 with no history of hepatitis C testing were due for a screening test. A hepatitis C care coordinator was also available to link people who test positive for hepatitis C antibodies to RNA testing and further hepatitis C related health care.

The testing results of one year of the intervention were compared with testing results from the year prior to the intervention.

Screening for hepatitis C antibodies increased 145%, from 5,767 in the year prior to the intervention to 13,390 in the year the screening program was implemented.

Through the hepatitis C care coordinator, access to testing for hepatitis C RNA following a positive hepatitis C antibody test increased from 83% to 95%. Of the people who received a positive RNA test, 94% were linked to care.

“Implementation of national guidelines for HCV screening at the health system level through a multi-pronged approach, including decision support tools within the [electronic health record] and dedicated care coordination, while requiring substantial initiative, has the potential to rapidly scale up hepatitis C screening and reduce gaps at every step in the hepatitis C care cascade,” (Healio.com, June 2017)

Epclusa is safe and effective for people with hepatitis C and HIV

Epclusa was well tolerated and had high cure rates in a late-stage clinical trial of people living with hepatitis C and HIV, reported researchers in Clinical Infectious Diseases.

While many treatment guidelines recommend that people with hepatitis C and HIV receive the same treatment as people mono-infected with hepatitis C, there is still a need for hepatitis C treatments that have few interactions with HIV medications.

In this trial, 101 participants received Epclusa for 12 weeks. Epclusa is a combination of two medications, sofosbuvir and velpatasvir, which are combined into one pill that is taken once per day.

Almost all (95%) of participants were cured from treatment. The most common side effects were fatigue (25%), headache (13%), joint pain (8%) and upper respiratory tract infection (8%). Two participants experienced serious adverse events and two participants discontinued because of adverse events.

“Sofosbuvir-velpatasvir for 12 weeks provides a simple, safe and highly effective treatment for patients coinfected with HCV and HIV”, concluded the researchers. (Healio.com, May 2017)

Drug-checking program reduced overdoses in people using drugs containing fentanyl

A pilot project to check the purity of drugs at Vancouver's Insite safe injection facility found that around 80% of tested samples contained fentanyl, and people who learned their drugs were contaminated were more likely to reduce their drug doses and less likely to overdose, reported researchers at the 25th International Harm Reduction Conference (HR17).

Fentanyl is a synthetic opioid that is 50 times stronger than heroin and is blamed for the increase in overdose deaths reported in the past few years in Vancouver and elsewhere in Canada.

A previous urine screening study found that among more than 200 participants tested at Vancouver harm reduction sites, 29% tested positive for fentanyl, and three-quarters of these people were not aware they had taken fentanyl.

In the current study, a total of 1138 drug checks were performed between July 2016 and March 2017, about 40% before consumption of drugs and about 60% afterwards.

The researchers found that, overall, 79% of all drug samples contained fentanyl. Contamination was more common in heroin and crystal methamphetamine samples (83% and 82%, respectively), and less so in samples of cocaine (40%) or other drugs (48%).

Only 10% of people whose drugs tested positive for fentanyl disposed of them. This is not surprising because clients were dependent on opioids and would get sick without them, and they knew injecting under supervision with naloxone on hand would be safer. But 64% did reduce their drug dose if they knew it contained fentanyl.

This programme "reduced overdose risks by helping clients identify contaminated drugs and be more cautious when injecting," the researchers concluded. (aidsmap.com, May 2017)

Straight to the source for new science

Living with Hepatitis C Virus: A Systematic Review and Narrative Synthesis of Qualitative Literature, Canadian Journal of Gastroenterology and Hepatology, April 2017