HepCInfo Updates

HepCInfo Update 8.17  

Welcome to CATIE's HepCInfo Update 8.17 for August 5 to August 18, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

New 8-week hepatitis C treatment effective in people co-infected with HIV and hepatitis C

In a late stage trial, a new eight week pan-genotypic hepatitis C treatment called Maviret cured almost all participants co-infected with hepatitis C and HIV, reported researchers at the International AIDS Society Conference on HIV Science (IAS 2017). 

Maviret is a combination of two direct-acting antiviral medications (DAAs), glecaprevir, a protease inhibitor, and pibrentasvir, an NS5A inhibitor. These medications are combined into one tablet. Maviret has recently been approved in Canada.

This combination was tested for eight weeks in people co-infected with hepatitis C and HIV who did not have cirrhosis and had never been treated. This trial is unique because European and American hepatitis C treatment guidelines have not recommended treatment options shorter than 12 weeks for people co-infected with hepatitis C and HIV. Participants in this trial who had cirrhosis were treated for 12 weeks.

The trial included 153 HIV-positive people with hepatitis C from Europe, Russia and the U.S. The majority of participants were men (80%) and the mid-range in age was 45 years. Two-thirds of participants had genotype 1 virus, 17% had genotype 3 virus, 11% had genotype 4 virus, a small number had genotype 2 or 6 virus and no one had genotype 5 virus. Most participants were taking HIV treatment (94%) and had well controlled HIV.

Of the participants that were treated for eight weeks, 99% were cured of hepatitis C. The overall cure rate for all participants, including those with cirrhosis who were treated for 12 weeks, was 98%. The most common side effects were fatigue, nausea, headache and nose and throat inflammation.

According to the researchers, “these results suggest that the glecaprevir and pibrentasvir regimen could be the first 8-week, pan-genotypic treatment option for hepatitis C/HIV co-infected patients without cirrhosis.” (HIVandhepatitis.com, July 2017)

DAA treatment reduces risk of death 18 months after treatment

There is a significant reduction in the risk of death during the year and a half after being cured of hepatitis C through direct-acting antiviral treatment (DAA), reported researchers in Clinical Infectious Diseases.

Researchers from ERCHIVES (US Electronically Retrieved Cohort of HCV Infected Veterans) compared 6970 people with hepatitis C who had been treated for at least two weeks with Holkira Pak or Harvoni to 6970 people with hepatitis C who were not treated.  

Amongst people who were treated and cured (also called a sustained virological response) of hepatitis C, there was a 43% reduction in the risk of death in the 18 months after the end of treatment.

The mid-range in age of participants was 61 years and most participants were male (96%). The majority of participants who were treated for hepatitis C were cured (94% of those who took Harvoni and 90% of those who took Holkira Pak).

Some significant differences existed between the group that was treated and the group that was not treated. Those who received DAA treatment were more likely to be obese and have cirrhosis but were less likely to have serious kidney disease, anemia, drug use issues or alcohol use issues.

According to the researchers, “Treatment for hepatitis C with either [Holkira Pak] or [Harvoni] and attainment of sustained virological response are associated with a significant reduction in mortality, a benefit that is seen within the first 18 months of treatment.” (infohep.org, August 2017)

Primary care doctors and nurse practitioners can effectively treat hepatitis C

Primary care doctors and nurse practitioners can administer hepatitis C treatment safely and effectively when compared with specialists, reported researchers in Annals of Internal Medicine.

In the U.S and Canada strategies that involve non-specialist health professionals providing hepatitis C treatment are seen as potential ways to expand access to new, improved treatments.

The researchers compared the cure rates of people treated for hepatitis C with Harvoni by primary care doctors, nurse practitioners or specialists at 13 health centres in Washington, D.C.

The health practitioners completed identical training based on American hepatitis C treatment guidelines. Of the 600 participants, 150 were treated by nurse practitioners, 160 were treated by primary care providers and 290 were treated by specialists.

After adjusting for possible confounders among participants, the overall cure rate was 87.1%. The cure rates were similar across provider type:

  • Primary care doctors, 87.6%
  • Nurse practitioners,  90.4% 
  • Specialists, 84.8%

 The most common cause of treatment failure was having participants be lost to follow up (7.5%).

According to the researchers, “In the [direct-acting antiviral] era, complete task shifting of hepatitis C therapy to general practitioners may be the ideal strategy for patients with uncomplicated infection.” (Healio.com, August 2017)

Straight to the source for new science

Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005-2014: The HITS-p study Journal of Viral Hepatitis, September 2017