HepCInfo Updates

HepCInfo Update 9.16  

Welcome to CATIE's HepCInfo Update 9.16 for July 21 to August 3, 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

World Health Organization recommends treating everyone with hepatitis C

The World Health Organization (WHO) has released new hepatitis care and treatment guidelines recommending that everyone with hepatitis C be treated with pan-genotypic treatments.

The new recommendations reflect an increase in the number of medications that can treat all genotypes of the hepatitis C virus (pan-genotypic medications), greater availability of these medications in low and middle income countries and research that demonstrates a benefit in treating people with little or no liver injury.

Additional recommendations in the guidelines include:

  • Treating everyone 12 years and older
  • Using pan-genotypic medications to avoid the need for genotype testing
  • Using simplified testing and treatment processes
  • Integrating hepatitis C testing and treatment into other services

For all of the recommendations, see Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection.

According to the WHO, “The guidelines enable major simplifications in the delivery of curative therapy to the 70 million people living with chronic hepatitis C in the world.” (infohep.org, July, 2018)

Many supervised drug consumption sites offer hepatitis C testing but few offer treatment

Most supervised drug consumption sites offer hepatitis C testing and referrals but few offer treatment, reported researchers at the International AIDS Conference in Amsterdam. 

This study surveyed 49 drug consumption sites in the Netherlands, Germany, Switzerland, Spain, Denmark, France, Australia, Canada, Luxembourg and Norway.

Almost all of the sites offered needles and syringes, condoms and referrals to health services, substance use treatment and other care. One-quarter offered opiate substitution therapy (OST) onsite. Most (89%) provided overdose management onsite and 37% gave out naloxone to clients.

Two-thirds of the sites offered hepatitis C testing, 25% offered liver monitoring through blood tests or Fibroscan but only 4% provided hepatitis C treatment.

An estimated 80% of clients were tested for hepatitis C and 60% tested positive for hepatitis C. Over half of clients (54%) were tested for HIV.

Many of the sites also offered a range of other health and social services, such as mental health care (44%), self-management support for chronic disease (50%) and access to showers and laundry (78%).

According to the researchers, “These facilities should be considered as a low-threshold HCV treatment provider for people who inject drugs on the community level; innovative arrangements should be sought." (infohep.org, August 2018)

People with mental health or substance use issues less likely to be treated for hepatitis C

People with mental health or substance use issues are less likely to be treated for hepatitis C compared to people without these conditions, reported researchers in Hepatology.

The study examined the data of 29, 544 people with hepatitis C who did or did not receive treatment between 2011 and 2017 at four large clinics in the U.S.

The participants were divided into two groups based on when they received care:

  1. Before DAAs were available, 2011-2013
  2. After DAAs were available, 2014-2016

Overall, 17% of participants were treated for hepatitis C. Treatment rates increased from the pre-DAA era to when DAAs were available (3.5% to 22%).

Over half of participants (59%) had a mental health or substance use diagnosis. People with mental health or substance issues were less likely than people without these conditions to be treated both before (adjusted odds ratio, 0.46) and after direct-acting antiviral (DAAs) medications became available (adjusted odds ratio, 0.63).

There were also differences in access to treatment based on race, age and health insurance status with white, middle-aged participants and people with health insurance being more likely to access hepatitis C treatment.

According to the researchers, “The goal of hepatitis C elimination requires a strategy that increases access to those with co-morbid illnesses, especially those with mental health and substance use, uninsured or underinsured populations, and all racial/ethnic minorities.” (infohep.org, July 2018)

Straight to the source for new science

A summary of the Pan-Canadian framework on sexually-transmitted and blood-borne infections, Canada Communicable Disease Report, July 2018
Hepatitis C virus infection in Saskatchewan First Nations communities: Challenges and innovations, Canada Communicable Disease Report, July 2018