HepCInfo Updates

HepCInfoUpdate 7.18  

Welcome to CATIE's HepCInfo Update 7.18 for September 17 to September 30, 2016. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Hepatitis C core antigen testing removes two-step process for diagnostic testing

Hepatitis C core antigen testing is a potential way for hepatitis C diagnostic testing to be simplified, reported researchers of a systematic review and meta-analysis in the Annals of Internal Medicine.

Current hepatitis C diagnostic testing consists of a hepatitis C antibody test to determine whether someone has ever had the hepatitis C virus. If a person tests positive for antibodies, a second different test is done to confirm that the person still has hepatitis C. This is because approximately 25% of people who get hepatitis C clear it without treatment.

To do the second test, called the hepatitis C RNA test, people must give another sample of blood. This means that a positive hepatitis C diagnosis requires two blood samples and three appointments.

Hepatitis C core antigen test checks for a protein of the hepatitis C virus (called the core protein). This test is also used to confirm a hepatitis C infection, so it can be used in place of the hepatitis C RNA test. One of the benefits of the core antigen test is that it can be done on the same blood sample as the antibody test. This decreases the number of blood samples that need to be taken and the number of appointments a person needs to have. A diagnosis could in many cases be given using one blood sample and two appointments.

The study found that two of the hepatitis C core antigen tests almost matched the accuracy of the hepatitis C RNA test when the viral load was over 3000 UI/mL. However, if a person’s viral load is below 3000 UI/mL there is a risk of the test giving a negative result when the person is actually positive for hepatitis C (called a false negative).

Hepatitis C core antigen testing is used in some parts of Canada. (HIVandhepatitis.com, June 2016)

US experts recommend people with hepatitis C be tested for hepatitis B before starting DAA treatment

The American Association for the Study of Liver Diseases (AASLD) has recommended that all people starting hepatitis C treatment with direct acting anti-viral (DAA) medications be tested for hepatitis B before starting treatment.

This is because if someone has hepatitis C and hepatitis B and is not receiving treatment for hepatitis B, treatment with DAAs could reactivate hepatitis B during or after treatment.

In some people with hepatitis B the virus is not very active and is not injuring the liver. However, when the hepatitis B virus is reactivated it can cause liver injury. When the hepatitis B virus is reactivated it can cause an increase in liver injury.  

Twenty-four cases of hepatitis B reactivation in people who have started DAA treatment for hepatitis C have been submitted to the U.S. Food and Drug Administration (FDA) between November 2013 and July 2016.

For more information about AASLD-IDSA’s recommendations for the testing, care and treatment of people with hepatitis C go to http://www.hcvguidelines.org/. (catie.ca, October 2016)

Routine hepatitis C screening for HIV positive gay men increases diagnoses

Implementing routine hepatitis C screening for HIV-positive gay men at a municipal STI clinic in Amsterdam increased diagnoses and resulted in earlier diagnoses, reported researchers in Sexually Transmitted Diseases.

American and European hepatitis C guidelines recommend that HIV-positive gay and bisexual men who have condomless sex be tested annually for hepatitis C. However, this is not widely implemented.

This study looked at people who tested positive for hepatitis C antibodies. People who test positive for antibodies need a second test to confirm that they have the hepatitis C virus to determine whether or not they currently have hepatitis C.

Of the 1724 HIV-positive men at the clinic, 112 tested positive for hepatitis C antibodies at their first visit. A total of 163 (9.5%) men tested positive for hepatitis C antibodies in the study and only 78 of them knew they had a history of hepatitis C. Of the other 85 people, information on where they were diagnosed was available for 54 men.  Of those people, 51.9%  were diagnosed at the STI clinic.

According to the researchers, “"The introduction of routine anti-HCV testing at the STI outpatient clinic resulted in additional and earlier HCV detection among HIV-positive MSM." (HIVandhepatitis.com, September 2016)

Straight to the source for new science

Hospitalizations in Immigrants and Nonimmigrants Diagnosed With Chronic Hepatitis C Infection in Québec, Clinical Infectious Diseases, September 2016, in English