HepCInfo Updates

HepCInfo Update 9.9 

Welcome to CATIE's HepCInfo Update 9.9 for April 14 to April 27, 2018. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Hepatitis C treatment restrictions removed for Alberta, Saskatchewan, Manitoba, Yukon and NIHB

Alberta, Saskatchewan, Manitoba, Yukon and the Non-insured Health benefits (NIHB) program, which provides health benefits to registered First Nations and recognized Inuit people, will cover the cost of hepatitis C treatment without restriction based on liver injury.

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. Prince Edward Island, Ontario, British Columbia and Quebec have previously lifted restrictions to hepatitis C treatment based on liver injury.

(ab.bluecross.ca, ehealthsask.ca, gov.mb.ca in English and French, hss.gov.yk.ca in English and French, canada.ca in English and French, April 2018)

Being cured of hepatitis C reduces the risk of heart attack and stroke in people with advanced liver injury

Being cured of hepatitis C is associated with a 65% reduction in risk of a major cardiovascular event such as a heart attack or stroke in people with advanced liver injury, reported researchers in the American Heart Journal.

The study included 878 adults with hepatitis C and advanced liver injury (compensated cirrhosis) from the French CirVir cohort. Data was gathered on hepatitis C cure rate (also known as a sustained virological response or SVR) and the rate of major cardiac events including stroke, heart attack, coronary artery disease, peripheral arterial disease, heart failure, cardiac arrest and death due to cardiovascular problems.

All participants received hepatitis C treatment between 2006 and 2012. The majority (67%) were treated with peg-interferon and ribavirin.

Participants were followed for about 58 months. In that time, 7% (61 people) had a major cardiac event.

After controlling for potential confounders, smoking, high blood pressure, Asian ethnicity and having low amounts of a protein made by the liver (albumin) were associated with an increased risk of a serious cardiac event.

A major cardiac event occurred in 1% of people who were cured compared to 10% in people who were not cured of hepatitis C.

According to the researchers, “We found that the main independent predictive factors of MACE [major adverse cardiovascular event] occurrence were Asian ethnic origin, arterial hypertension, and low serum albumin and that an SVR was associated with a decreased risk of MACE. Further studies are warranted to evaluate whether a similar benefit can be obtained in less severe patients, such as non-cirrhotic hepatitis C-infected patients.”

(infohep.org, April 2018)

Mail invitation for hepatitis B and C testing improves uptake in immigrant communities

Inviting people by mail to be tested for hepatitis B and C resulted in an increase in testing and identification of previously undiagnosed infections in communities with a high percentage of immigrants and newcomers, reported researchers at the International Liver Congress in Paris.

The study randomized 58 primary care practices in three areas of England with large immigrant populations to screen people for hepatitis B and C. Fifty practices were randomly selected to carry out the screening program (the intervention group) and eight were selected as the control group.

The screening program included mailing either a standard invitation letter in the participant’s first language or a standard letter and a brochure about hepatitis C. The clinics in the control group received training on hepatitis B and C but did not send out invitations. Each practice received the equivalent of 44 Canadian dollars per person screened.

Participants were selected for screening if they or their parents immigrated from a country with a prevalence of hepatitis B or C of 2% or greater. In the intervention group, 58,512 people were eligible to be invited for screening. In the control group, 31,738 people were eligible for screening.

Of the intervention group, almost 20% (11,611 people) attended hepatitis testing. Uptake was highest (32%) in people from Bangladesh, India and Pakistan. It was lowest in Afro-Caribbean participants (9%). People over the age of 40 were more likely to come for testing compared to younger adults (28% vs 14%). In the control group, 555 participants (2%) were tested.

People who tested positive for hepatitis B or C were referred for follow up care in the community or hospital.

According to the researchers, “Targeting standard screening invitation letters to migrants over 40 years of age is likely to prove most effective, and that primary care practices should receive financial incentives for viral hepatitis case-finding in the same way as for some other health conditions.”

(infohep.org, April 2018)

Straight to the source for new science

Declining hepatitis C virus incidence in Dutch human immunodeficiency virus-positive men who have sex with men after unrestricted access to HCV therapy, Clinical Infectious Diseases, April 2018.