HepCInfo Updates

HepCInfo Update 9.10  

Welcome to CATIE's HepCInfo Update 9.10 for April 28 to May 11, 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

Fatigue improved for over half of people cured of hepatitis C

Fatigue improved for over half of people cured of hepatitis C 12 weeks after the end of treatment, reported researchers at the 2018 International Liver Congress in Paris.

Fatigue is a common symptom of hepatitis C.

The study was a secondary analysis of people who were cured of hepatitis C using a sofosbuvir-containing treatment. The 6113 participants had also completed a questionnaire (FACIT-F scale) with 13 questions about fatigue before treatment and 12 weeks after treatment.

Just over one-third of participants had severe liver injury (cirrhosis).

Forty-five percent of participants experienced an improvement in fatigue compared to before treatment and 12% reported that they no longer felt fatigue or had minimal fatigue. Forty-two percent who experienced severe fatigue did not have an improvement in fatigue scores.

Fatigue was more likely to improve in younger people, people without cirrhosis and in people with fewer health conditions. Depression, anxiety, insomnia, type 2 diabetes, cirrhosis and co-infection with HIV were associated with a lack of improvement in fatigue.  Note that all of these conditions can cause fatigue.

According to the researcher, “Longer-term follow-up of people with severe fatigue would be useful so as to give a clearer understanding of the likelihood of improvement beyond the SVR12 visit, the pace of recovery and longer-term risk factors for persistent fatigue after hepatitis C is cured.” (infohep.org, May 2018)

Hepatitis C point-of-care testing acceptable and feasible for people who inject drugs

Point-of-care hepatitis C testing was acceptable and feasible for people who inject drugs, reported researchers at the 2018 International Liver Congress in Paris.

Researchers identified 174 people who were considered to be at high risk for hepatitis C at three needle and syringe programs in Australia. Participants were tested for hepatitis C antibodies with a mouth swab test. If the results were positive, they were tested with a hepatitis C RNA test that takes about an hour and a half for results.

Same day results were delivered at the site, or through phone calls or text messages or at a later date when the person returned to the clinic.

Of the total participants, 86% (150 people) tested positive for hepatitis C antibodies, of those 140 (93%) took the hepatitis C RNA test and 54% (76) tested positive.

The majority of participants chose to receive test results by phone or text message (61%), while only 5% remained onsite to wait for their results. There were 67 participants who had not returned for their results within four weeks, however during that time 40 of those people were linked to care through the study.

Most participants (85%) preferred point-of-care testing over the standard hepatitis C testing process which can take one to two weeks for results to be returned.

According to the researchers, “The turnaround times for test results were too slow for [participants] to receive same-day, on-site results but despite this, we did have good rates of follow-up, which shows this model can successfully link people who inject drugs into hepatitis C care.” (Healio.com, April 2018)

Combined hepatitis C treatment and OST increased adherence for people who use opiates

Offering hepatitis C treatment combined with opiate substitution therapy helped to increase adherence for people who inject drugs, reported researchers at the 2018 International Liver Congress in Paris.

The study included 90 participants who had injected opioids within the past three months and who had not previously been treated with direct-acting antiviral medications and who visited an urban harm reduction centre in Washington, DC.

About three-quarters of participants were men, the majority were black people (90%) and the mid-range in age was 56 years. Half of participants had unstable housing and more than 90% had been in prison.

Sixty per cent injected opioids at least once a day, and more than one-quarter reported sharing injection equipment.

Participants receive Epclusa for 12 weeks. Epclusa is a combination of two direct-acting antiviral (DAA) medications, sofosbuvir and velpatasvir. They are combined into one tablet that is taken once per day. Epclusa is effective against all genotypes of the hepatitis C virus.

Participants were also offered buprenorphine, a medication that relieves opiate withdrawal symptoms and reduces cravings for opiates. These medications were given at the same time as Epclusa.

About a third (30%) were already on buprenorphine at the start of the study, 39 people (43%) started buprenorphine and 22 people (24%) did not use any medication-assisted treatment.

At the time of the analysis, 55 participants had reached 24 weeks of post-treatment follow-up. Among the 46 people with available viral load data, 91% were cured of hepatitis C. Of the total 55 people, 76% were cured, 13% missed the study visit, 7% were not cured, 2% had died and 2% were still waiting for results.

People who were either on opioid substitution therapy at baseline or who started buprenorphine were significantly more likely to attend clinic visits than those not on any medication-assisted treatment. Attendance at week four was 95%, 89% and 71%, respectively. Attendance was lowest at week 12 (86%, 81% and 40%, respectively), but increased again by week 24 (88%, 86% and 67%).

According to the researchers, “Hepatitis C treatment may provide a critical opportunity to not only cure hepatitis C, but simultaneously prevent re-infection and treat opioid use disorder in high-risk, marginalized [people who inject drugs]." (infohep.org, May 2018)

Straight to the source for new science

Direct‐acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease, Hepatology, May 2018