HepCInfo Updates

HepCInfo Update 8.14  

Welcome to CATIE's HepCInfo Update 8.14 for June 24 to July 7, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Urban clinic achieves high cure rates in people with hepatitis C and HIV co-infection

People with hepatitis C and HIV co-infection had high cure rates after hepatitis C treatment in an urban clinic program with nurse and pharmacist support, reported researchers in Hepatology.

The researchers analyzed the hepatitis C outcomes of 255 patients who had previously been enrolled in the Johns Hopkins HIV or HIV/HCV clinical cohort studies between February 2014 and March 2016, in Baltimore, Maryland.

Most participants were men (73%) and black (88%). The mid-range in age was 44 years. Just over half of participants reported receiving psychiatric diagnoses (57%) and just under three quarters (73%) had a history of street drug use. Almost all (97%) participants were taking HIV treatment.

The majority of participants (91%) received Harvoni with or without ribavirin for 12 weeks.

Participants received adherence support from an HIV nurse and a pharmacist, which included nurse visits and telephone calls. Participants received more frequent support if they needed it.

Of the 255 participants, 97% (246 people) were cured of hepatitis C. This cure rate did not vary by race, history of injection drug use, alcohol use or psychiatric diagnosis. Participants with HIV viral suppression had a higher cure rate than those who were not fully virally suppressed (97.7% vs. 87.9%).

“The consistently high rates of SVR [sustained virological response] in our cohort, regardless of race or other potentially negative predictors of SVR such as a drug or hazardous alcohol use or mental health diagnoses may be related to the unique hepatitis C care model implemented in our clinical practice which is centered on care delivery by the patient’s HIV care nurse with support from an integrated specialty pharmacy”, concluded the researchers. (Healio.com, June 2017)

Experimental treatment is effective in DAA-experienced people

An experimental treatment combination of sofosbuvir, velpatasvir and voxilaprevir for 12 weeks was effective in people with genotype 1 virus who had previously been treated with DAAs, reported researchers in Hepatology.

Sofosbuvir, velpatasvir and voxilaprevir are three direct-acting antiviral medications (DAAs) that are combined into one pill and taken once per day.

The trial included 49 participants, 25 of whom took sofosbuvir, velpatasvir and voxilaprevir (SOF/VEL/VOX) with ribavirin for 12 weeks and 24 who took the treatment without ribavirin.

Most participants were younger than 65 years (90%), white (80%) and men (65%). Fifty-one percent had cirrhosis and most (88%) had been treated for hepatitis C only once prior to this study. Thirty-five patients had resistant-associated substitution (RAS) which means the hepatitis C virus they have is resistant to one or more classes of hepatitis C medications.

Twenty-four of the 25 patients who received SOF/VEL/VOX with ribavirin and all the patients who received SOF/VEL/VOX were cured. The most common side effects were diarrhea (13%) and bronchitis (8%). Participants who also took ribavirin had the following side effects, fatigue (36%), anemia (16%), gastroenteritis (8%) and nausea (8%).

“The addition of ribavirin ... has been shown to improve rates of [sustained virologic response] in response to treatment with a number of regimens...It appears that the combination of [these] three highly potent DAAs can obviate the need for [ribavirin] to be included in a regimen to maximize efficacy”, concluded the researchers. (Healio.com, June 2017)

Test ordering system update and screening guideline education increases hepatitis C testing among people with HIV

Adding hepatitis C virus screening to an automated set of tests for people with HIV and educating health care providers about testing guidelines greatly increased hepatitis C testing at a Massachusetts clinic, reported researchers in Open forum Infectious Diseases.

The hepatitis C screening was added to the hospital’s outpatient electronic laboratory ordering system, and was activated Jan. 1, 2014. Soon after, clinicians were informed via email about the addition to the order set and given updated hepatitis C screening guidelines. They also held conferences in January 2014 and again in January 2015 to review the guidelines and discuss results.

The study included 350 people living with HIV, 57% of whom were white. Men comprised 80% of the study group, 74% of whom were men who have sex with men (MSM).

During 2014 and 2015, 287 (82%) of the participants visited the clinic and 80% (229) were screened for hepatitis C in either year. Most participants (62%) were screened in both years.

Seven people (3.1%) tested positive for hepatitis C (1.57 new cases per 100 person-years). This was triple the rate of hepatitis C detection before the new program was started (0.46 new cases per 100 person-years).

An average of about 11% of participants per year were screened in the four years before the screening intervention, compared with 54% in the 2 years after the intervention began.

According to the researchers, “early diagnosis and treatment of HCV in people living with HIV will decrease morbidity and mortality and will slow the HCV epidemic.” (Healio.com, June 2017)

Straight to the source for new science

Canadian harm reduction policies: A comparative content analysis of provincial and territorial documents, 2000–2015, The International Journal of Drug Policy, July 2017