HepCInfo Update 9.14 | CATIE - Canada's source for HIV and hepatitis C information

HepCInfo Updates

HepCInfo Update 9.14 

Welcome to CATIE's HepCInfo Update 9.14 for June 23 to July 6, 2018. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

We sometimes report on experimental use of hepatitis C drugs. For information on the approved use of hepatitis C treatment in Canada, see the Hepatitis C drugs approved in Canada for adults chart and fact sheets on each hepatitis C treatment.

New and noteworthy

TreatmentUpdate: Multi-disciplinary care helps to prevent re-infection

There were no cases of re-infection in people who use drugs who received multi-disciplinary care before, during and after hepatitis C treatment, reported researchers at the International Liver Congress in Paris, France.

The researchers reviewed the medical records of 148 people with hepatitis C who used drugs and attended the Vancouver Infectious Disease Centre.

The majority of participants were men (79%). The average age was 69 years. Most people used heroin (66%) and 44% used cocaine, with some people using both drugs.

All participants received treatment with direct-acting antiviral (DAA) medications between June 2015 and May 2017. The most commonly used medications were Epclusa, Harvoni, Holkira Pak and Zepatier. All participants were cured of hepatitis C.

Participants also received multidisciplinary care including general medical care, mental health care, support for substance use issues and social needs.

After an average of 66 weeks of care, no participant became re-infected with hepatitis C and no participant died of a drug overdose.

It is possible that the multidisciplinary care and services provided by the clinic not only helped to prevent re-infection with HCV but also helped to prevent fatal overdoses. (catie.ca, June 2018)

High cure rates with Epclusa for people with genotype 3 and advanced liver injury

In real world settings, people with genotype 3 virus and advanced liver injury had cure rates over 90% with Epclusa, reported researchers in Gastroenterology.

With older hepatitis C treatments, people with genotype 3 virus and advanced liver injury (cirrhosis) were less likely to be cured.

The 204 participants in this study received either Epclusa (101) or Epclusa and ribavirin (103) for 12 weeks. The study took place at 29 sites in Spain between August 2016 and April 2017.

Epclusa consists of two direct-acting antiviral (DAA) medications, sofosbuvir and velpatasvir, which are co-formulated into a single tablet.

In the group of people who received Epclusa and ribavirin 96% (99) were cured. In the group who received Epclusa 91% (92) were cured.

Forty-one participants had a strain of the hepatitis C virus that is resistant to one class of medications (NS5A inhibitors) that is included in Epclusa. If a person has a hepatitis C strain that is resistant, they are sometimes not cured from treatment with medications from this class of drug.

Among people treated with Epclusa and ribavirin, 22 people had resistance but 21 were cured (95%) and in the group treated with Epclusa, 19 people had resistance and 16 were cured (84%). 

Epclusa with or without ribavirin was well tolerated. The most common side effects were fatigue, headache and insomnia.

According to the researchers, “Consistent with findings from earlier studies, a high rate of patients (91% and 95%) with genotype 3 HCV infection with compensated cirrhosis achieved an SVR12 after 12 weeks of treatment with sofosbuvir/velpatasvir, with or without ribavirin.” (Healio.com, June 2018)

Harm reduction programs to prevent and treat hepatitis C lacking in European prisons

Harm reduction measures for the prevention and treatment of hepatitis C in prisoners are lacking in the majority of European countries, reported researchers in the Harm Reduction Journal.

The study looked at the availability of needle and syringe programmes, opioid substitution therapy (OST), screening for and treatment of hepatitis C in prisons in 25 European countries between 2016 and 2017.

The study is part of Hep-CORE, which is a cross-sectional study of viral hepatitis policy implementation in Europe, using responses from hepatitis patient groups.

The main findings included:

  • only nine countries had identified prisoners as a priority group for screening
  • 16 countries reported no hepatitis C screening policy for prisoners
  • 21 countries provide treatment to some prisoners
  • only five countries (Slovakia, Slovenia, Spain, Sweden and the United Kingdom) provide hepatitis C treatment in all prisons
  • only 2 countries have prison needle and syringe programs (Romania and Spain)
  • 11 countries offer opioid substitution therapy to prisoners
  • Four out of the eleven countries that provide OST only give OST to people already taking OST at the time of imprisonment

According to the researchers, “Harm reduction, hepatitis C testing/screening, and treatment should be scaled up in prison settings in order to progress towards eliminating hepatitis C as a public health threat.” (infohep.org, May 2018)

Straight to the source for new science

Hepatitis C in patients with minimal or no hepatic fibrosis: The impact of treatment and sustained virologic response on patient-reported outcomes, Clinical Infectious Diseases, June 2018

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