HepCInfo Updates

HepCInfo Update 9.12  

Welcome to CATIE's HepCInfo Update 9.12 for May 25 to June 8, 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

New Canadian hepatitis C treatment guidelines released

New Canadian hepatitis C treatment guidelines have been released by the Canadian Association for the Study of the Liver in the Canadian Medical Association Journal.

These guidelines include many recommendations for care providers, including:

  • Expanding hepatitis C screening to adults born between 1945 and 1975
  • Providing a comprehensive pre-treatment evaluation including viral load, genotype and liver injury level assessment
  • Offering treatment to all people who test positive for chronic hepatitis C
  • Using only oral direct-acting antiviral treatments
  • Individualizing treatment, especially for people with other chronic health issues
  • Providing long term surveillance for liver cancer in people with cirrhosis post-treatment

Recognizing that there are highly effective oral hepatitis C treatments available, the guidelines highlight the need for an increased focus on prevention, screening and linkage to care in order to effectively address hepatitis C in Canada.

The guidelines also emphasize the need to expand the number of treatment providers so more people can receive hepatitis C care and treatment.  This includes increasing the capacity of primary care providers to provide treatment, especially those who work with populations most affected by hepatitis C, such as prisoners, people who use drugs and Indigenous people.

According to the researchers, “Beyond treatment, addressing hepatitis C in Canada will require coordination of services to address harm reduction and many of the social determinants of health that have an impact on the bur­den and course of HCV­-related disease.” (CATIE News, June 4, 2018)

DAA treatments safe and effective in people who inject drugs

Direct-acting antiviral treatments delivered through a multi-disciplinary team are safe and effective for people who inject drugs, reported researchers from British Columbia in Open Forum Infectious Diseases.

The researchers examined data from 291 clients with hepatitis C who started direct-acting antiviral (DAA) treatment between May 1, 2014 and December 31, 2017 at the Vancouver Infectious Disease Centre.

Of this group 88% (256) had a history of injection drug use, 46% (134) injected drugs in the past six months and 36% (105) were receiving opiate substitution therapy.

Participants received one of three DAA treatments, Epclusa, Harvoni or Zepatier

The multi-disciplinary team included infectious disease specialists, nurses and logistic support people, who provided support for mental health, substance use, social and medical needs. Participants also had access to weekly education and support groups, nutritional assistance and access to non-prescription medications.

By December 31, 2017, results were available for 229 people and 62 people were still being treated. The overall cure rate was 90% (207). Two people died after treatment for reasons unrelated to treatment. The prevalence of loss to follow up was 6% (13 people).

The cure rate was slightly lower (84%) in people who had injected drugs in the past six months. This was related to people in this group being lost to follow up rather than not being cured from treatment.

According to the researchers, “HCV treatment delivered to PWID within a multidisciplinary program of care to address medical, social, psychological and addiction-related aspects of care leads to very high [cure] rates and very low rates of loss to follow up, irrespective of the DAA regimen that is prescribed.” (Healio.com, June 2018)

Straight to the source for new science

Interventions to increase testing, linkage to care and treatment of hepatitis C virus (HCV) infection among people in prisons: A systematic review, The International Journal of Drug Policy, July 2018