HepCInfo Updates

HepCInfo Update 9.4 

Welcome to CATIE's HepCInfo Update 9.4 for February 3 to February 16. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

High cure rates and adherence in clinical trial with people who inject drugs

Most participants in a clinical trial of people who had recently used injection drugs were cured from treatment and had high rates of adherence, reported researchers in The Lancet Gastroenterology and Hepatology.

The study included 103 participants, 28% (29) were women and 9% (9) had cirrhosis. All participants had injected drugs in the past six months, 59% (61) were receiving opiate substitution therapy, 74% (76) had injected in the past month and 26% (27) had injected daily in the past month.

Participants were treated with Epclusa (velpatasvir and sofosbuvir) for 12 weeks.

Almost all participants completed treatment (97% or 100 people). Of these, 97 people were cured. There were no participants who had virologic failure or relapse.

Adherence ranged from 88% to 98% with 68 participants taking their medication at least 90% of the time.

The cure rate did not differ between people who had injected drugs more frequently and those use injected less often.

According to the researchers, “Hepatitis C treatment should be offered to people who inject drugs, irrespective of ongoing drug use.” (Healio.com, February 2018)
High HCV viral load, low CD4 count and other factors linked to people with HIV/HCV not being cured of HCV

For people with both HIV and hepatitis C not being cured of hepatitis C was linked to HIV immunosuppression, hepatitis C viral load, liver injury, using certain treatments and gender, reported researchers in Hepatology.

Most people who have HIV and hepatitis C are cured of hepatitis C through treatment with direct-acting antiviral medications (DAAs).

However, a large Spanish study was able to determine what factors are linked to not being cured from treatment for the small numbers of people who experience this.

The study included 2, 396 people with HIV and hepatitis C coinfection who were treated with direct-acting antiviral regimens. Most participants were men (78.2%) and the mid-range in age was 51 years.

Participants were treated with Harvoni (61.9%), sofosbuvir and daclatasvir (14.6%), Holkira Pak (13.2%), or other treatments (10.3%). Just under one-third also took ribavirin (30.6%).

The overall cure rate was 92%. Participants who were less likely to be cured from treatment had one or more of the following factors: male gender, low baseline CD4 count (less than 200 cells/mm3), high hepatitis C viral load (800,000 IU/mL or higher), severe liver injury or liver failure.

Participants who received the combination of sofosbuvir and simeprevir, sofosbuvir and ribavirin or daclatasvir and simeprevir, also had higher odds of not being cured.

According to the researchers, “In this large real-world study, DAA-based therapy was safe and highly effective in co-infected patients. Predictors of failure included gender, HIV-related immunosuppression, HCV RNA load, severity of liver disease, and the use of suboptimal DAA-based regimens.”

Curing hepatitis C in people with no advanced liver injury reduces mortality

People without advanced liver injury who were cured of hepatitis C had significantly reduced mortality from any cause, reported researchers in Hepatology.

The study included 40, 664 U.S. Veterans with hepatitis C who did not have advanced liver disease and received hepatitis C treatment with direct-acting antiviral (DAA) medications. The study also had a comparison group of 60, 682 people with hepatitis C without advanced liver disease who were not treated.

Of the participants that received hepatitis C treatment, 96.8% were cured (39, 374 people) and 3.2% were not cured (1,290 people).  The majority of people (65%) received treatment with Harvoni (ledipasvir and sofosbuvir).

In comparison to people who were not treated, people who were cured of hepatitis C had a 68% reduced rate of mortality.

Compared to people who were treated but not cured of hepatitis C, people who were cured had a 56% reduction in mortality rate.

According to the researchers, “Successfully treating hepatitis C with DAAs in patients without clinically apparent advanced liver disease translates into a significant mortality benefit.” (Healio.com, January 2018)

Straight to the source for new science

Determinants of hepatitis C antiviral effectiveness awareness among people who inject drugs in the direct-acting antiviral era, International Journal of Drug Policy, February 2018