HepCInfo Updates

HepCInfo Update 8.16 

Welcome to CATIE's HepCInfo Update 8.16 for July 22 to August 4, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

FDA approves 8-week DAA treatment for all Hep C genotypes

The U.S. Food and Drug Administration approved a direct-acting antiviral (DAA) drug combination that is only taken for eight weeks and is effective against all hepatitis C genotypes.

The DAA combination is called Mavyret and is a combination of glecaprevir, a protease inhibitor, and pibrentasvir, an NS5A inhibitor. These medications are combined into one tablet and a person takes three tablets once per day.

Mavyret is approved as an eight-week treatment in people without cirrhosis who have not previously been treated for hepatitis C. The majority of currently available treatments are taken for 12 weeks.

Mavyret is also approved for people with moderate to severe kidney disease and people on kidney dialysis. Currently, this group has limited treatment options. It is also approved for people who have been previously treated with different regimens for eight, 12 or 16 weeks.

In clinical trials of a total of 2,300 participants with genotype 1 to 6 virus with mild or no cirrhosis, who took treatment for eight, 12 or 16 weeks, 92% to 100% of participants were cured. The most common side effects were headache, fatigue and nausea.

This medication is not currently approved in Canada. (fda.gov, August 2017)

Late diagnoses of hepatitis C in people with advanced liver injury decreasing in B.C.

Late diagnoses of hepatitis C have declined over time in British Columbia in people with decompensated cirrhosis and those with liver cancer, reported researchers in the Journal of Hepatology.

Detecting hepatitis C early and treating and curing the virus can prevent the most advanced complications of the disease, such as decompensated cirrhosis (when the liver is so damaged it can no longer function properly) and liver cancer.

Researchers analyzed patient data from the British Columbia Hepatitis Tester’s Cohort, which included 57, 866 people with hepatitis C. Of these 3, 962 people (6.8%) had decompensated cirrhosis and 902 people (1.6%) had liver cancer. Among people with decompensated cirrhosis, 1,566 (40%) had a late diagnosis of hepatitis C. Among people with liver cancer, 283 (31%) had a late diagnosis.

Over time late diagnoses in people with hepatitis C decreased from 89.5% (1992 to 1996) to 20.4% (2007 to 2011) among those with decompensated cirrhosis. Late diagnoses of hepatitis C decreased from 85.7% (1992 to 1996) to 29.4% (2007 to 2011) in people with liver cancer.

People with decompensated cirrhosis who had a late diagnosis were more likely to be born before 1945, to be materially deprived, to use street drugs, have a mental health diagnosis and to have fewer annual hospital visits.

People with liver cancer who had a late diagnoses were more likely to be born before 1945, live in an urban setting and have a history of street drug use and alcohol use.

 “…Our results identify groups that are being missed for screening such as those who do not see a physician regularly, those who are less visibly at risk and those with serious mental illness; innovative strategies to address these gaps for appropriate secondary prevention and treatment for these groups should be explored”, concluded the researchers. (Healio.com, July 2017)

Hepatitis C still high in HIV-positive men who have sex with men in Europe

Hepatitis C incidence is increasing overall among HIV-positive men who have sex with men in Europe although there are regional differences, reported researchers in the Journal of Hepatology.

The researchers analyzed data from HIV-positive men who have sex with men (MSM) collected between 1990 and 2014 from the CASCADE Collaboration (Concerted Action on SeroConversion to AIDS and Death in Europe).

Of 5,941 MSM, 337 became hepatitis C-positive between 1990 and 2014. The hepatitis C incidence rate in 2014 (18/1,000 person-years) was 25.7 times higher than it was in 1990 (0.7/1,000 person-years).

Being a younger age, having recently acquired HIV, having higher HIV viral load levels and having data collected in recent calendar years were significantly associated with becoming hepatitis C-positive.

Throughout Europe, hepatitis C incidence increased in Northern Europe, stabilized in Western Europe and remained stable in Southern Europe. The time between a person becoming HIV-positive and then becoming hepatitis C positive decreased over time.

According to the researchers, “No decline in hepatitis C incidence was observed in recent years, although trends seem to differ by geographical region. Hepatitis C screening among HIV-positive MSM should be continued and routinely offered.” (Healio.com, July 2017)

Straight to the source for new science

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study, Journal of Viral Hepatitis, August 2017

Understanding patient perceptions and risk for hepatitis C screening, Journal of Viral Hepatitis, August 2017