HepCInfo Updates

HepCInfo Update 9.6  

Welcome to CATIE's HepCInfo Update 9.6 for March 3 to March 16, 2018. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Ontario, B.C. and Quebec to cover hepatitis C treatment regardless of liver injury level

Ontario, B.C., and Quebec will cover the cost of hepatitis C treatment without restrictions based on liver injury. Ontario and B.C. lifted these restrictions as of February 28, 2018, and Quebec lifted restrictions as of March 1, 2018.

Prior to this change, people needed to have a certain level of liver injury (fibrosis stage 2) in order to be eligible for treatment coverage.  Or, if a person’s level of liver injury was less than fibrosis stage 2 they needed to have another health issue in addition to hepatitis C, such as HIV, hepatitis B or diabetes to qualify for treatment coverage.

(health.gov.on.ca, February 2018; news.gov.bc.ca, March 2018; inesss.qc.ca, March 2018, in French)

Spontaneous clearance of hepatitis C low in people with HIV coinfection

Most people with HIV who contract hepatitis C will not spontaneously clear hepatitis C, reported researchers at the Conference on Retroviruses and Opportunistic Infections in Boston, Massachusetts.

Between 2007 and 2016 the researchers documented 465 cases of acute hepatitis C in people with HIV from Austria, Denmark, France, Germany, Italy, the Netherlands, Switzerland and the U.K. Each person was followed for at least one year.

The median (mid-range) age of participants was 41 years. Almost all participants were men (98%). Most participants were taking HIV treatment (92%) and of these people 91% had an undetectable HIV viral load.

Fifty-five participants (12%) spontaneously cleared hepatitis C. In people who are mono-infected with hepatitis C, the rate of spontaneous clearance of hepatitis C is up to 25%.

Of the people who developed a chronic hepatitis C infection, 325 people (70%) received pegylated interferon and ribavirin or interferon-free DAA treatment and 246 people were cured (76%).

People who experienced a significant decline in hepatitis C viral load (more than a 2-log decrease) by week four of having hepatitis C were more likely to spontaneously clear the virus.

According to the researchers, “…treatment initiation needs to be considered early on to prevent onward transmission to sex partners.”

(Healio.com, March 2018)

Unrestricted access to treatment nearly eliminates hepatitis C in an Australian prison

In less than two years, a treatment program at an Australian prison cured 97% of prisoners with hepatitis C, reported researchers in Clinical Infectious Diseases.

The World Health Organization (WHO) has identified micro-elimination as a strategy to reduce the rate of hepatitis C in sub-populations most affected by hepatitis C, such as prisoners. With this approach, treatment is scaled up for specific groups with the goal of eliminating hepatitis C within smaller pockets of the population.

In the first 22 months of the program, approximately 90% of new prisoners to the facility were tested for hepatitis C. All 125 people who tested positive for hepatitis C were offered treatment with direct-acting antiviral medication (DAA) for eight, 12 or 24 weeks.  Of those, 119 started treatment. The most common treatment (41%) was sofosbuvir and daclatasvir taken for 12 weeks.

Participants also received counselling and education about hepatitis C reinfection and were linked to care in the community when they left prison.

Of the 119 people who began treatment, 98 people had completed treatment by the end of the study. Thirty-two of these people were lost to follow up mainly through being released from prison or being transferred to another prison.

Of the 66 people who remained in the study, 64 (97%) were cured of hepatitis C.

The researchers estimated that hepatitis C prevalence at the prison decreased from 12.6% before the program started, to 4.3% after one year of the program and 1.1% after 22 months.

According to the researchers, “The close relationship between injecting drug use, incarceration, and prevalence of blood-borne viruses makes correctional centres a crucial setting for enhanced DAA therapy access and broad prevention strategies.”

(Healio.com, March 2018)

Straight to the source for new science

Scoping out the literature on mobile needle and syringe programs—review of service delivery and client characteristics, operation, utilization, referrals, and impact, Harm Reduction Journal, February 2018