HepCInfo Updates

HepCInfo Update 9.13 

Welcome to CATIE's HepCInfo Update 9.13 for June 9 to June 22, 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

Success with HCV treatment for people with HCV and HIV but half remain untreated

A study of hepatitis C elimination initiatives found high rates of hepatitis C treatment completion and cure rates among people with hepatitis C and HIV, but only half were receiving treatment, reported researchers in the Journal of the International AIDS Society.

The study assessed data about the cascade of care from seven hepatitis C elimination initiatives and studies among people with hepatitis C and HIV co-infection. These were carried out in Australia, Canada, France, Georgia, the Netherlands and Switzerland.

Of the seven studies, four focused on hepatitis C elimination in gay and bisexual men living with HIV and three included a combination of people who inject drugs, gay and bisexual men, and other people living with HIV. None of the studies included people in prison.

Across the seven projects, 4894 people with HIV tested positive for hepatitis C. Of those 48% (2338) had started hepatitis C treatment. Among the studies with treatment completion data, 96% (1061 of 1109) had completed treatment. Of the participants with data about whether they were cured from treatment, 93% were cured (1631 of 1757).

According to the researchers, “Early data from the direct-acting antiviral era suggest that hepatitis C treatment uptake has increased in HIV‐infected populations compared to previous levels, but there is still considerable work to do on the pathway to hepatitis C elimination in this population.” (avert.org, May 2018)

Fatty liver and liver stiffness improved in people cured of hepatitis C

Fatty liver and liver stiffness improved in people treated with direct-acting antivirals and cured, reported researchers in Alimentary Pharmacology and Therapeutics.

Fatty liver, which is also known as steatosis, is a buildup of fat deposits in the liver. More advanced steatosis is linked to increased liver injury and liver cancer. It is also associated with a greater risk of heart disease.

There is minimal research about how steatosis is impacted by curing hepatitis C.

The researchers took measurements of steatosis, liver stiffness and other liver health markers prior to treatment (baseline) and 24 weeks post-treatment from 198 people who received direct-acting antiviral treatment.

Steatosis was significantly reduced 24 weeks after treatment compared to baseline measurements (2.4% to 1.9%) as was liver stiffness (3.10 kPa to 2.80 kPa).

Of those with a clinical diagnosis of fatty liver disease (a high level of steatosis, greater than 5.2%), 68% did not have fatty liver disease at the end of 24 weeks follow up.

According to the researchers, “Viral eradication reduces both liver stiffness and steatosis in patients with chronic HCV who received direct-acting anti-viral therapy…further studies are warranted to confirm these findings in other populations.” (infohep.org, June 2018)

Community-based liver injury screening feasible

Community-based liver screening found similar numbers of people with advanced liver injury compared to people cared for by a specialist hospital clinic, reported Australian researchers in the Journal of Hepatology.

Participants included 780 people with hepatitis C from 21 primary care practices and 207 patients with hepatitis C from a hospital. All of the participants selected from the community had not seen a specialist in 18 months and had no prior history of liver cancer.

Over a period of 26 months, all community participants were recruited and received a clinical assessment, blood tests and were tested for liver fibrosis using Transient elastography (Fibroscan).

The mid-range in liver stiffness measurement was 6.9 kPa for the community participants with 17% being at risk for advanced liver injury (cirrhosis). The risk of cirrhosis was similar for the hospital and community participants.

According to the researchers, “Our data suggests that rates of advanced fibrosis in the community are significant (17%), often underdiagnosed and comparable to rates seen in specialist referral centres.” (Healio.org, May 2018)

Straight to the source for new science

Assessing hepatitis C spontaneous clearance and understanding associated factors-A systematic review and meta-analysis, Journal of Viral Hepatitis, June 2018.