World Health Organization (WHO) released its global report on access to hepatitis C treatment in low and middle-income countries. Here is the report and press release.​

Publication details

Number of pages: 68
Publication date: October 2016
Languages: English
WHO reference number: WHO/HIV/2016.20


News release

Over 1 million treated with highly effective hepatitis C medicines
High prices–a major barrier to access

27 October 2016 | GENEVA - Over one million people in low- and middle-income countries have been treated with a revolutionary new cure for hepatitis C since its introduction two years ago.

When Direct Acting Antivirals (DAAs) were first approved for hepatitis C treatment in 2013, there were widespread fears that their high price would put them out of reach for the more than 80 million people with chronic hepatitis C infections worldwide.

The new medicines have a cure rate of over 95%, fewer side effects than previously available therapies, and can completely cure the disease within three months. But at an initial estimated price of some US$85 000 they were unaffordable even in high-income countries.
Countries show hepatitis C treatment is achievable

Thanks to a series of access strategies supported by the World Health Organization (WHO) and other partners, a range of low- and middle-income countries, including Argentina, Brazil, Egypt, Georgia, Indonesia, Morocco, Nigeria, Pakistan, Philippines, Romania, Rwanda, Thailand and Ukraine – are beginning to succeed in getting drugs to people who need them. Strategies include competition from generic medicines through licensing agreements, local production and price negotiations.

"Maximizing access to lifesaving hepatitis C treatment is a priority for WHO," says Dr Gottfried Hirnschall, Director of WHO's Department of HIV and Global Hepatitis Programme. "It is encouraging to see countries starting to make important progress. However, access still remains beyond the reach for most people."

A new WHO report, Global Report on Access to Hepatitis C Treatment: Focus on Overcoming Barriers, released today shows how political will, civil society advocacy and pricing negotiations are helping address hepatitis C, a disease which kills almost 700 000 people annually and places a heavy burden on health systems’ capacities and resources.

"Licensing agreements and local production in some countries have gone a long way to make these treatments more affordable," says Dr Suzanne Hill, WHO Director for Essential Medicines and Health Products. For example, the price of a three-month treatment in Egypt dropped from US$900 in 2014 to less than US$200 in 2016.

"But there are still huge differences between what countries are paying. Some middle-income countries, which bear the largest burden of hepatitis C, are still paying very high prices. WHO is working on new pricing models for these, and other expensive medicines, in order to increase access to all essential medicines in all countries," says Dr Hill.

80% of people in need still face challenges

Among middle-income countries, the price for a three-month treatment of sofosbuvir and daclatasvir varies greatly. Costs range from US$9 400 in Brazil to US$79 900 in Romania.

High costs have led to treatment rationing in some countries, including in the European Union, where price agreements have not accounted for the full cost of treating the whole affected population.

"Today's report on access, prices, patents and registration of hepatitis C medicines will help create the much needed market transparency which should support country efforts to increase access to DAAs," said Dr Hirnschall. "We hope countries will update their hepatitis treatment guidelines, work to remove barriers to access, and make these medicines available promptly for everyone in need."

In May 2016, at the World Health Assembly, 194 countries adopted the first-ever Global Health Sector Strategy on Viral Hepatitis, agreeing to eliminate hepatitis as a public health threat by 2030. The strategy includes a target to treat 80% of people in need by this date.

WHO issued guidelines recommending the use of DAAs in 2014 and 2016 and included DAAs on its Essential Medicines List – which is compiled to address the priority healthcare needs of populations; to make needed essential medicines available at all times in adequate amounts, at a price the health system and community can afford.

Buyers’ Clubs: Generic versions of HCV drugs resulted in very high cure rates

Generic hepatitis C

Keith Alcorn
Published: 27 October 2016

Use of generic versions of direct-acting antivirals resulted in very high cure rates for people who obtained the products through three buyers’ clubs, indicating that the generics products are effective, according to three presentations at the International Congress on Drug Therapy in HIV Infection in Glasgow this week.

People who purchased the drugs were cured of hepatitis C at a cost of around $700-$900, Dr Andrew Hill of St Stephen’s AIDS Trust, London, reported in three poster presentations at the conference.

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The Changing HCV Landscape: Update on Treatment

Gastroenterology & Endoscopy News

The Changing HCV Landscape: Update on Treatment

Review Article
OCTOBER 26, 2016
DAAs for HCV infection have all but replaced IFN as the foundation of treatment for HCV across all genotypes. Among the major advantages of these oral regimens, beyond their remarkable efficacy, has been their relatively clean safety profile. Adverse effects are common but generally mild, including headache, fatigue, and insomnia—and are trivial relative to the effects of earlier regimens, reflected by a low rate of discontinuation for adverse events. Clinicians must be aware of potential drug–drug interactions, and should prescribe these medications with a commitment toward mastering these and/or consulting the numerous published and online references, including package inserts, containing this information...

Continue to article....

Review - Laboratory tests relevant for the treatment of HCV infection in the era of DAA therapy

Clinical Laboratory Testing in the Era of Directly Acting Antiviral Therapies for Hepatitis C

Full Text Article
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Citation Wilson EM, Rosenthal ES, Kattakuzhy S, Tang L, Kottilil S. 2017. Clinical laboratory testing in the era of directly acting antiviral therapies for hepatitis C. Clin Microbiol Rev 30:23–42.

Directly acting antiviral (DAA) combination therapies for chronic hepatitis C virus (HCV) infection are highly effective, but treatment decisions remain complex. Laboratory testing is important to evaluate a range of viral, host, and pharmacological factors when considering HCV treatment, and patients must be monitored during and after therapy for safety and to assess the viral response. In this review, we discuss the laboratory tests relevant for the treatment of HCV infection in the era of DAA therapy, grouped according to viral and host factors.

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Full Text Articles
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C. A link to the above mentioned article (PDF) was tweeted by Mr. Chang this morning.

Liver Awareness Month: What pain medication can Liver Disease patients take? Is milk thistle good for my liver?

Liver Awareness Month, Nana and Zombies
October has been busy around here folks, fall is one of our favorite times of the year. Nana and the little people finally completed our little Halloween horror movie, a family tradition since 2013. I am hoping this isn't the last year, but it could be.

People are saying (my daughter) that I went a bit too far this year. Note to self; during lunch never film a bloody zombie attack - especially at Taco Bell.

Who knew our blood curdling screams would offend so many people. I ask you; how scary can a four and eight year old be? After the manager explained the situation, I somewhat understood. Manager Frank made a special appearance in "Zombies Eat Tacos - Not People" I love the title too, brainchild of the baby!

Liver Awareness Month
Moving on to something more important, as most of you know October is both Liver and Liver Cancer Awareness Month. Yes, because of my movie career I almost missed it. Not to worry, the wonderful website of the American Liver Foundation (ALF) just published their E-Newsletter "LIVERLOWDOWN" chock–full of great information about the causes, symptoms and risk factors associated with liver disease.
Begin here....

ALF Mayo Nutrition and Wellness Liver Chat
In addition, last month ALF along with experts from the Mayo Clinic and University of Florida Health hosted a Q&A on Twitter about liver wellness and nutrition. Below I condensed the chat highlighting the questions and answers, or view the Liver Chat on Twitter here. Enjoy.

Panelists Weigh in on Liver Nutrition
Is milk thistle good for my liver? How about the Paleo diet? Leading experts from the Mayo Clinic and University of Florida Health answered these questions and more at ALF’s September Nutrition Tweet Chat. Three transplant hepatologists and a dietician weighed in on wellness and nutrition.

American Liver Foundation (ALF) - The first topic we will be covering is liver disease and diet

Q1. Why do people who have never consumed alcohol get Liver Disease?
A1. Many causes besides alcohol. Your doctor will check to see if you have a condition requiring specific treatment.

Q2. What kinds of processed or salty foods should patients with ascites/edema limit?
A2. Patients should read nutrition labels. Common culprits include frozen meals, deli meats, chips, fast food

Q3. Is it healthy to skip meals or try to drastically decrease calorie intake to lose weight?
A3. Patients with cirrhosis can often suffer from malnutrition. The key to losing weight: healthy diet and exercise.

Q4. For patients with issues such as nausea or lack of appetite, are smaller meals better than 3 meals/day?
A4. Smaller, frequent meals can be beneficial. Especially to those with slow gastric emptying and decreased appetite.

Q5. Next, what are some smart snacks to pack or have on hand, instead of reaching for candy or chocolate?
A5. High protein stacks are always favorable: nuts, seeds, yogurt, protein bars, or high protein shakes.

Q6. Patients often ask, you recommend the DASH diet to all patients?
A6. Despite limited data showing the benefits of DASH for Fatty Liver Disease, I recommend discussing with your dr.

Q7. What foods should I be eating if I have liver disease and low platelets? Or what if I'm anemic?
A7. Drink 1.5-2 L water per day, but avoid all fruit juice. Make sure you eat 3-4 servings vegetables, 2 servings fruit. Fruit juice contains significant amounts of fructose sugar- metabolized like fat. Also eat 4 servings whole grains/day, 3 servings low fat dairy. Try eating 1-2 servings ocean fish weekly, 2 egg yolk. Finally, avoid meats/sausages/butter/vegetable oil. And limit sodium (<2g daily), as well as processed and restaurant foods!

Q8. If I have fatty liver disease- are there good fats I should consume or should all be eliminated for your diet?
A8. Avoid fried foods, pizza, and sausage. Choose ocean fish, which are good sources of Omega-3 fatty acids.

Q9. The Paleo diet is popular- but is it a good choice for overall wellness?
A9. No, too much saturated fat and minimal whole grains. It's easy to develop Vitamin B deficiencies

Q10. If I have too much iron in blood- are there foods I should avoid or limit consumption of?
A10. Avoid red & processed meats, fatty foods, supplemental Vitamin C, sugary foods/beverages. DO eat nuts, grains, rice & beans.

Q11. Very popular question: Is coffee OK to consume? How many cups a day is OK?
A11. 2-3 6-8oz cups of coffee daily are fine.

Q12. If you have ascites/edema (water retention), what kinds of processed or salty foods should you limit consumption of?
A12. Avoid processed foods, salty foods, sausage, pizza, and baked goods like muffins. Minimize restaurant foods.

Q13. For patients w/issues such as nausea or lack of appetite- are smaller meals better than 3 square meals per day?
A13. 4-6 meals per day helps meet your calorie and protein needs. Remember to included a good source of protein w/ every meal.

Q14. Is the DASH diet one that you would recommend for all liver patients?
A14. DASH diet benefits most patients except for those on a low potassium diet.
Basic DASH Diet includes 7 day meal plan with 2000 calories, 100 gram protein, 1500 mg sodium-(link) As the responses from the experts keep coming in, we're moving onto our next topic- supplements, liver function, and medication

Q15. What is the best test to assess liver function?
A15. No single test. Blood tests + imaging assess functions and complications of Liver Disease. Liver biopsy can also provide valuable diagnostic info.

Q16. What pain medication can Liver Disease patients take?
A16. No more than 2gm acetaminophen (Tylenol and its related medications) in 24 hrs. Avoid NSAIDs if you have cirrhosis

Q17. Is it ok for patients with Liver Disease to take statin meds?
A17. Yes, statins may be taken to treat high cholesterol. Recent studies suggest statins may help patients with cirrhosis.

Q18. Is milk thistle okay to take?
A18. We usually refer people to speak with their nutritionists/providers/pharmacists to double check out supplements. Clinical evidence for milk thistle isn't established but may benefit some types of liver disease. Studies are inconclusive. However, available evidence suggests that milk thistle is likely harmless with minimal minor side effects.

Q19. Should you be consuming large amounts of protein? Are protein shakes ok? What are ways to consume protein w/o added sugar?
A19. A good guide is 25-30 g of protein per meal, unless you have chronic kidney disease. Focus on fish, chicken, dairy, and vegetable proteins. Protein shakes or bars may help if you can't eat enough.

Q20. Our last question before answering some from the chat: Are probiotics OK for someone to take if they have liver disease?
A20. Yes, but make it a food source like Greek yogurt or kefir. Speak to you doctor before taking any supplements.

Liver Chat participants
Q Is jogging safe for someone with stage 3 liver disease?
A There is no reason not to consider jogging with stage 3 fibrosis. Enjoy!

Q Should I expect my MELD score to drop after hepatitis c treatment?
A Generally yes, we do see improvements in MELD after treatment for HCV

Q At what bilirubin range should a patient get listed? Or is it MELD 15?
A Patients are evaluated for liver transplantation generally at meld15 or with symptoms of liver decompensated (confusion, ascites)

Q What causes liver to produce high HDL even though eat healthy all life?
A You're lucky if you have HDL cholesterol. Patients with low HDL and high LDL are at greater risk of heart disease.

Q Vitamin B12 shots post transplant?
A b12 shots should be provided if patients are deficient

Q Any advice on naturally reducing a FNH liver mass?
A There is no diet or natural therapy to reduce FNH.

Q Any specific suggestions for someone with Autoimmune Hepatitis?
A Would AIH require any specific requirements on diet or just good liver nutrition as highlighted in chat. Autoimmune hepatitis requires assessment with blood tests + liver biopsy. Rx with prednisone + azathioprine usually effective.

Q Are there specific risk factors for African American men and Liver disease?
A Actually fatty liver disease in African Americans, has a better prognosis.

More From ALF
October is big for the liver community. It's Liver Awareness Month- and it's also Liver Cancer Awareness Month, so we've teamed with Bayer to help raise awareness about the risk factors for this deadly disease. Learn more about liver cancer here.

Questions about liver disease? Need support or resource info? Call our helpline at 1-800-465-4837, 9am-7pm ET Mon-Fri.

Hope you all have a wonderful week and Halloween, until next time.
Bad Grandma - AKATina

Scotland - Liver cancer death rate rises by 52%

Liver cancer death rate rises by 52%
Death rates from liver cancer increased by 52% in the last 10 years, with the disease killing 572 Scots last year.

But new figures from the NHS showed that the cancer mortality rate for all forms of the disease fell by 11% over the decade to 2015.

The mortality rate for breast cancer - the most commonly diagnosed cancer for women - fell by 21%
Lung cancer death rates were down by 15.1% and there was a 16.4% decrease for bowel cancer.

A total of 16,011 deaths in 2015 were caused by cancer, with the report noting that "although the rate of deaths due to cancer has decreased over this period, the actual number of deaths due to cancer has not".

This is thought to be due to the increase in older age groups within the population and the fact that cancer is a relatively common disease among the elderly.

Cancer mortality rates have fallen by 14% among men over the last 10 years. The decrease in the mortality rate for females was lower at 6%.

Deaths from liver cancer were up from 320 in 2005, with the mortality rate increasing by 45.6% in males and by 68.6% for females.

"The increase in the mortality rate of liver cancer over the last 10 years by 52% reflects the increase in incidence of this type of cancer," the report said.

"Survival from liver cancer is poor in most cases. The main risk factors for liver cancer are alcohol and infection with hepatitis B and C."

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