Showing posts with label HCV Australia. Show all posts
Showing posts with label HCV Australia. Show all posts

Wednesday, August 22, 2018

Drop in Aussies seeking hepatitis C cure

More than 170,000 Australians are able to access subsidised medication to cure Hepatitis C but the number of people choosing to do so is declining.

Chief investigator Margaret Hellard told AAP she hopes to see 15,000 people a year accessing treatment to reduce the number of people dying and the rate of transmission.

Ensuring health practitioners are aware of the treatment, who is eligible and how to treat patients with hepatitis C is also part of the plan, being launched by Health Minister Greg Hunt in Canberra on Wednesday night.

It's hoped the partnership will result in a 65 per cent reduction in hepatitis C related deaths and an 80 per cent reduction in new infections....


Source: AAP

Monday, August 13, 2018

Listen: Fewer Australians are dying from hepatitis C, but thousands are still missing out on treatment

Article
Fewer Australians are dying from hepatitis C, but thousands are still missing out on treatment
By health reporter Olivia Willis
Monday 13 August 2018
The number of Australians dying from liver failure and liver cancer related to hepatitis C has dropped by 20 per cent in just two years, according to preliminary data released today by The Kirby Institute.
Read the article: http://www.abc.net.au/news/health/2018-08-13/fewer-australians-dying-from-hepatitis-c/10107326

ABC Radio Australia 
Deaths from Hep C liver failure and liver cancer improving
Listen to Monday's Health Report hosted by Dr. Norman Swan with guest Greg Dore discuss the latest hepatitis C-related liver failure and liver cancer figures in New South Whales.

Deaths from Hep C liver failure and liver cancer improving
New research is showing a return on the Federal Government's investment in free hepatitis C treatment aimed at curing blood-transmitted liver infection.

The latest figures from New South Wales show the number of people dying from hepatitis C-related liver failure and liver cancer has dropped 20 per cent in two years.

Listen here...…

Guest: Professor Greg Dore
Professor and Program Head, Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales.

Monday 13 August 2018 5:45PM (full episode)

Tuesday, June 19, 2018

High-coverage treatment scale-up is required if Australia is to eliminate HCV as a public health threat

PLoS ONE 13(6): e0198336.
Hepatitis C virus notification rates in Australia are highest in socioeconomically disadvantaged areas
Samuel W. Hainsworth, Paul M. Dietze,David P. Wilson, Brett Sutton, Margaret E. Hellard, Nick Scott

Published: June 18, 2018

High-coverage treatment scale-up is required if Australia is to eliminate HCV as a public health threat, and this scale-up is necessary now if we are to achieve the WHO elimination targets by 2030. While this is only a preliminary analysis of the HCV burden, the findings provide important information for service prioritisation and planning, highlighting that the per capita burden of HCV is greatest in socioeconomically disadvantaged areas and the unmet demand for HCV services is greatest in geographic areas outside major cities. Our results suggest that strategies for HCV prevention and treatment in Australia would benefit from considering these factors. Any future research which has access to testing and treatment data could provide greater insight for the development of needs-based service planning. Despite this, the data used in our analysis are routinely available demographic and health service data, meaning that our analysis can serve as a useful framework for the ongoing monitoring of Australia’s efforts to eliminate HCV. Additionally, a similar framework for service planning could be employed in other countries wanting to scale up HCV testing and treatment in an effort to achieve HCV elimination.


Full Article

Abstract
Background
Poor access to health services is a significant barrier to achieving the World Health Organization’s hepatitis C virus (HCV) elimination targets. We demonstrate how geospatial analysis can be performed with commonly available data to identify areas with the greatest unmet demand for HCV services.

Methods
We performed an Australia-wide cross-sectional analysis of 2015 HCV notification rates using local government areas (LGAs) as our unit of analysis. A zero-inflated negative binomial regression was used to determine associations between notification rates and socioeconomic/demographic factors, health service and geographic remoteness area (RA) classification variables. Additionally, component scores were extracted from a principal component analysis (PCA) of the healthcare service variables to provide rankings of relative service coverage and unmet demand across Australia.

Results
Among LGAs with non-zero notifications, higher rates were associated with areas that had increased socioeconomic disadvantage, more needle and syringe services (incidence rate ratio [IRR] 1.022; 95%CI 1.001, 1.044) and more alcohol and other drug services (IRR 1.019; 1.005, 1.034). The distribution of PCA component scores indicated that per-capita healthcare service coverage was lower in areas outside of major Australian cities. Areas outside of major cities also contained 94% of LGAs in the lowest two socioeconomic quintiles, as well as 35% of HCV notifications despite only representing 29% of the population.

Conclusions
As countries aim for HCV elimination, routinely collected data can be used to identify geographical areas for priority service delivery. In Australia, the unmet demand for HCV treatment services is greatest in socioeconomically disadvantaged and non-metropolitan areas.

Thursday, May 24, 2018

Elimination of Hepatitis C Virus in Australia: Laying the Foundation

The following full-text article is available for download, shared by Henry E. Chang via twitter

Elimination of Hepatitis C Virus in Australia: Laying the Foundation
Gregory J. Dore BSc, MBBS, MPH, FRACP, PhD Behzad Hajarizadeh MD, MPH, PhD

https://doi.org/10.1016/j.idc.2018.02.006

INTRODUCTION
The development of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is one of the great advances in clinical medicine in recent decades. Involving simple (once daily oral dosing), tolerable, short duration (8–12weeks), and highly efficacious (cure rates of >95%) regimens, DAA therapy has the potential to markedly increase HCV treatment uptake and turn around the escalating global disease burden associated with chronic HCV infection.1 The transformative nature of DAA therapy underpinned the development of World Health Organization(WHO) goals to eliminate HCV as a public health threat, which include 80% of eligible patients treated, a 65% decrease in HCV-related mortality, and an 80% decrease in new HCV infections by 2030.

KEY POINTS
-Australia has laid the foundation for hepatitis C virus elimination within the next decade.
-Key aspects of this foundation include high levels of screening and diagnosis, unrestricted access to direct-acting antiviral therapy, a diverse range of models of care, and high coverage of harm reduction strategies.
-Key features include government risk-sharing arrangement with the pharmaceutical companies, minimal out-of-pocket cost, no restrictions based on liver disease stage or drug/ alcohol use, prescribing authorization for all registered medical practitioners; and retreatment is allowed.
-Although initial uptake of direct-acting antiviral therapy was high, more efforts are required to continue the momentum.
-An hepatitis C virus elimination monitoring and evaluation program is in progress to inform further strategies required to achieve hepatitis C virus elimination targets

Article: https://jumpshare.com/v/Iu5mE4qtidIUDyEpjMz2

Tuesday, April 24, 2018

Implementation of hepatitis C cure in Australia: one year on

J Virus Erad. 2018 Apr 1;4(2):115-117.
Implementation of hepatitis C cure in Australia: one year on.
Richmond JA, Wallace J1.

Full Article
View Online

Abstract
Objectives:
Direct-acting antivirals (DAAs) for the treatment of hepatitis C (HCV) became universally available in Australia in March 2016, with an aim to achieve HCV elimination. Fourteen per cent of Australians with HCV have initiated treatment. The objective of this study was to explore and identify challenges and enablers that have emerged during this initial phase of HCV cure implementation.

Methods:
Key stakeholders (KS) in primary care, non-government and government sectors were recruited to participate in a telephone-based semi-structured interview to describe challenges and enablers facing individuals with HCV and the healthcare system in implementing HCV cure. Data were thematically analysed.

Results:
Eleven KS participants were interviewed with each commending the significantly increased numbers of people accessing HCV treatment since March 2016. There was concern that this momentum was waning and that targeted interventions to normalise HCV treatment within primary care were needed. Furthermore, workforce development activities needed to acknowledge the priority of HCV elimination, and develop training and resources for clinicians, most of whom had limited HCV experience. The role of professional champions and multidisciplinary teams of both clinical and non-clinical workers was identified as critical for services that had cured a significant number of people with HCV.

Conclusions:
Australia has many of the essential elements necessary to eliminate HCV, including universally funded DAA access and multiple treatment access points through primary care. Additional systematic activity is needed to ensure that the DAA-access momentum is maintained and HCV elimination achieved.

Tuesday, February 13, 2018

Capacity of non-invasive hepatic fibrosis algorithms to replace transient elastography to exclude cirrhosis in people with HCV

Capacity of non-invasive hepatic fibrosis algorithms to replace transient elastography to exclude cirrhosis in people with hepatitis C virus infection: A multi-centre observational study
Melissa Louise Kelly ,Stephen M. Riordan,Rohan Bopage,Andrew R. Lloyd,Jeffrey John Post

Published: February 13, 2018
https://doi.org/10.1371/journal.pone.0192763

View Full Text Online

Abstract
Introduction
Achievement of the 2030 World Health Organisation (WHO) global hepatitis C virus (HCV) elimination targets will be underpinned by scale-up of testing and use of direct-acting antiviral treatments. In Australia, despite publically-funded testing and treatment, less than 15% of patients were treated in the first year of treatment access, highlighting the need for greater efficiency of health service delivery. To this end, non-invasive fibrosis algorithms were examined to reduce reliance on transient elastography (TE) which is currently utilised for the assessment of cirrhosis in most Australian clinical settings.

Materials and methods
This retrospective and prospective study, with derivation and validation cohorts, examined consecutive patients in a tertiary referral centre, a sexual health clinic, and a prison-based hepatitis program. The negative predictive value (NPV) of seven non-invasive algorithms were measured using published and newly derived cut-offs. The number of TEs avoided for each algorithm, or combination of algorithms, was determined.

Results
The 850 patients included 780 (92%) with HCV mono-infection, and 70 (8%) co-infected with HIV or hepatitis B. The mono-infected cohort included 612 men (79%), with an overall prevalence of cirrhosis of 16% (125/780). An ‘APRI’ algorithm cut-off of 1.0 had a 94% NPV (95%CI: 91–96%). Newly derived cut-offs of ‘APRI’ (0.49), ‘FIB-4’ (0.93) and ‘GUCI’ (0.5) algorithms each had NPVs of 99% (95%CI: 97–100%), allowing avoidance of TE in 40% (315/780), 40% (310/780) and 40% (298/749) respectively. When used in combination, NPV was retained and TE avoidance reached 54% (405/749), regardless of gender or co-infection.

Conclusions
Non-invasive algorithms can reliably exclude cirrhosis in many patients, allowing improved efficiency of HCV assessment services in Australia and worldwide.

Monday, February 12, 2018

Hepatitis C drugs not being accessed by thousands of Australians with the disease

Hepatitis C drugs not being accessed by thousands of Australians with the disease
By Lexi Metherell

The trend means the Government is at risk of missing its target to eradicate hepatitis C and of spending far more than necessary on the treatments.

Hepatitis Australia said fewer than half as many people were accessing the direct acting antivirals as they were immediately after they were first listed on the Pharmaceutical Benefits Scheme (PBS) in March 2016.

Thursday, August 10, 2017

Australia - A note of caution amidst a ‘revolution’ in hepatitis C treatment

A note of caution amidst a ‘revolution’ in hepatitis C treatment

Tens of thousands of Australians have been cured of Hepatitis C since new treatments were made universally available last year, and a report released last month said Australia is on track to eliminate hepatitis C by 2026.

But while new treatments continue to dramatically reshape the landscape, data from the Centre for Social Research in Health’s (CSRH) Annual Report of Trends in Behaviour 2017: Viral Hepatitis in Australia underscores the need for caution.

Addressing stigma in healthcare settings, engaging marginalised communities in prevention, and continuing to trial innovative models of care will all be imperative if the ‘new era’ of treatment is to fulfil its promise, the report says.

The report will be presented on 10 August at the Australasian Viral Hepatitis Elimination Conference (AVHEC) in Cairns.

The Annual Report of Trends in Behaviour presents data from a selection of the behavioural and social research conducted by the CSRH. It is designed to inform prevention, diagnosis and treatment by critiquing and questioning the assumptions that sometimes underlie research, policy and practice around viral hepatitis.

Key issues in the 2017 report on viral hepatitis include:
The need to continually innovate harm reduction programs in ways that reflect how transmission happens in the everyday
Exploring best models of care for affected communities
The impact of stigma on the capacity of affected communities to navigate treatment systems
Understanding and preventing hepatitis C transmission within heterosexual couples
Examining strategies beyond equipment distribution
Gaps in the way that hepatitis C prevention sector understands and addresses risk

Lead author Dr Joanne Bryant, Senior Research Fellow at the CSRH, said the report particularly highlighted the challenges of testing, diagnosis and care of Aboriginal people with hepatitis C.

“While we found that Aboriginal Australians living with hepatitis C were generally satisfied with their care, they were often subject to stigma and discrimination, which can create a barrier in accessing healthcare,” Dr Bryant said. “Policies and programs need to be culturally tailored to address the unique needs and experiences of Aboriginal people living with hepatitis C and their communities.”

The report found that most hepatitis C infections occur early in people’s drug using pathways but many young people had limited knowledge about the availability of sterile injecting equipment.

In a survey of 210 socially marginalised young people at risk of transitioning to injecting drug use, a third (34.3%) of participants thought they knew where to obtain sterile needles, fewer (24.3%) could correctly identify a service, and the sources most commonly identified – hospitals (27.8%) and pharmacies (25.0%) – were not specifically needle distribution services.

“These findings suggest that needle distribution policies should focus less on getting ‘at-risk’ young people to visit primary needle and syringe programs and more on improving services that they already know about, such as hospitals and pharmacies, or finding ways of bringing sterile needles to them, such as through peer distribution,” Dr Bryant said.

The report also notes that despite the majority of needle or syringe sharing occurring between sexual partners, the framing and delivery of harm reduction in Australia has little capacity to recognise intimate partnerships, including addressing the hepatitis C risks specific to them.

“Not only might more effective harm reduction strategies be achieved by moving to a practice framework that addresses the social context of injecting, including the experience of couples, the broader drug treatment and hepatitis C care sectors might also benefit from recognising the importance that partnership plays in the lives of couples who inject drugs,” Dr Bryant said.

The report also examines risks factors, attitudes and knowledge of hepatitis B, and highlights that about one third of people living with the diseases are yet to be diagnosed and only 6% have been treated.

Stigma remains a factor influencing decisions about care and treatment of people living with hepatitis. But for those diagnosed with liver cancer, the report says lack of English-language proficiency can be a barrier to accessing health services and understanding the implications of a cancer diagnosis.

“Our recommendations include a directory of Chinese-speaking medical practices and Chinese language interpretation services, the development of Cantonese and Mandarin language health promotional materials, and identifying opportunities to support family doctors and liver specialists,” Dr Bryant said.

Professor Carla Treloar, Director of the CSRH, said: “Viral transmission happens in complex ways that are impacted by social context and the relationships of people at risk of acquiring viral hepatitis. Within the exciting context of new generation hepatitis C treatments, there remains the need to continually innovate harm reduction programs in ways that reflect how transmission happens in the everyday.”

The full report is available here.

Media contact: Clare Morgan, UNSW Media Office, clare.morgan@unsw.edu.au, 02 9385 8920, 0416 127 312

Wednesday, August 9, 2017

Focus on primary care before we run out of hep C patients, says Ed Gane

Regular news from the New Zealand Doctor newsroom

Focus on primary care before we run out of hep C patients, says Ed Gane
Cliff Taylor
But the flow of easy-to-reach patients, treated mainly in hospital clinics, is coming to an end. The pressing need is to engage with the 48,000 patients believed to be in the community, he says.

Treatment rate plateauing 
Until March, between 150 and 200 patients were being treated each month, but the number is now about 105.

“We wouldn’t expect that to be happening so soon,” Professor Gane says. “We would have expected it to remain high, or increase.”

Continue reading...

Thursday, July 27, 2017

Australia - 'We have been waiting for so long': hep C patients get access to new cure

'We have been waiting for this moment for so long': hepatitis C patients have access to cure with Epclusa PBS listing
Kate Aubusson
More than 200,000 Australians with hepatitis C will soon be able to afford a new, highly effective treatment for the chronic, highly stigmatised infection.
From August 1, the Turnbull government will subsidise the drug Epclusa, a bumper medication combining the two antivirals sofosbuvir and velpatasvir, Health Minister Greg Hunt is set to announce on Friday.
Continue reading....

Tuesday, July 25, 2017

NSW Podcast - Australia Hepatitis B and Hepatitis C

Sydney Sexual Health Centre

Welcome to the third episode of the new Sydney Sexual Health Centre podcast! This episode ties into Hepatitis Awareness Week, which is held at the end of July and incorporates World Hepatitis Day on July 28th. Two campaigns will run throughout July in the lead up to Hepatitis Awareness Week and World Hepatitis Day.

We talk to Stuart Loveday from Hepatitis NSW about hepatitis B and hepatitis C, as well as the state-wide hepatitis B and hepatitis C awareness campaigns.



More on the hepatitis B campaign: www.hepB.org.au
More on the hepatitis C campaign: www.hepC.org.au
More on Hepatitis NSW: www.hep.org.au
More on Sydney Sexual Health Centre: www.sshc.org.au

Tuesday, July 4, 2017

Australian NSP Survey National Data Report - Nationally initiation of HCV treatment increased in 2016


Australian NSP Survey National Data Report 2012 – 2016


Description 
The Australian Needle and Syringe Program Survey (ANSPS) provides serial point prevalence estimates of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) antibodies and sexual and injecting risk behaviour among people who inject drugs (PWID) in Australia. Conducted annually over a one-two week period in October, all clients attending participating needle and syringe program (NSP) services are invited to complete a brief, anonymous questionnaire and to provide a capillary blood sample for HIV and HCV antibody testing.

This report presents national and state/territory data for the period 2012 to 2016.
Key findings 
  • In 2016, 50 Australian Needle and Syringe Programs (NSPs) participated in the ANSPS and 2,210 NSP attendees completed the survey. The response rate was 41%.
  • Over the period 2012 to 2016, the median age of survey respondents increased from 38 years to 42 years, with a concurrent decrease in the proportion of young injectors (aged <25 years) from 7% in 2012 to 4% in 2016.
  • HIV antibody prevalence remained low and stable nationally, ranging from 1.2% to 2.1% over the period 2012 to 2016
  • Hepatitis C virus (HCV) antibody prevalence was stable over the period 2012 to 2016, ranging from 51% to 57%.
  • Nationally, the proportion of respondents who reported recent (last 12 months) initiation of HCV treatment was low and stable at 1-3% between 2011-2015, but increased significantly to 22% in 2016, with substantial increases observed in all jurisdictions.
Source

Tuesday, May 30, 2017

QUEST TO QUASH THE STIGMA: Joshua Roberts hopes to quash the stigma surrounding hepatitis C

Joshua Roberts has lived with hepatitis C most of his life, now he's cured and wants to quash the stigma so others can get help
Rachel Baxter

Joshua Roberts is on a mission to quash the stigma surrounding hepatitis C – a virus that is slowly killing more than 200,000 Australians.

A former sufferer himself, last year Mr Roberts spoke up about his experience in an article published by the Guyra Argus.

Since then, the Guyra resident said a number of people had come forward in his community who were before suffering in silence, due to fear of being socially shunned.
Continue reading....

Tuesday, October 4, 2016

Treatment of HCV infection should be considered for everyone in Australia who has a chronic infection


A practical overview of the treatment of chronic hepatitis C virus infection
Khoo A, et al. Aust Fam Physician. 2016.

Authors
Khoo A, Tse E.
Citation Aust Fam Physician. 2016 Oct;45(10):718-720.

Full Text Article
Download PDF or  View Online

Abstract
BACKGROUND: Although hepatitis C virus (HCV) infection is associated with significant morbidity and mortality, OBJECTIVE: This article provides an overview for GPs on the principles involved in assessing and treating patients with chronic hepatitis C within a community setting.

DISCUSSION: Treatment with DAA medications listed on the PBS should be considered for all patients with chronic HCV infection. These regimens are well tolerated, highly efficacious and have all-oral administration. A thorough pre-treatment evaluation should be undertaken, and patients with cirrhosis, significant comorbidities or potential drug-drug interactions should be referred to a specialist. Successful eradication of HCV is characterised by undetectable HCV ribonucleic acid viral load on polymerase chain reaction testing 12 weeks after treatment completion, although antibodies to HCV may remain positive for the rest of the patient's life.

Affecting more than 230,000 individuals in Australia, hepatitis C virus (HCV) infection is a common cause of chronic liver disease, leading in many cases to cirrhosis, decompensated disease, liver cancer and death.1,2 Despite significant morbidity and mortality, it is estimated that <2% of people with chronic HCV infection receive treatment.3,4 A key contributor to this low treatment uptake has been a lack of infrastructure available to administer therapy, which was previously undertaken only through specialist liver disease clinics or via specially trained and accredited GPs.5

As of March 2016, new oral direct-acting antiviral (DAA) treatments for HCV became available on the Pharmaceutical Benefits Scheme (PBS) for patients >18 years of age in Australia. These treatments can be prescribed by GPs in consultation with a gastroenterologist, hepatologist or infectious diseases physician experienced in the treatment of chronic HCV infection.6
Logistically, the nature of this consultation varies in different states and territories; however, most patients with uncomplicated HCV infection can be treated in the community without being seen by a specialist. The nationally standardised Remote consultation request for initiation of hepatitis C treatment form from the Gastroenterological Society of Australia (available at www.gesa.org.au/professional.asp?cid=77&id=454) is an easily accessible document that can be submitted to many treatment centres in Australia for sighting and approval by an appropriate physician.

Implementation of the new treatment paradigm has far-reaching implications, as the vast majority of patients with chronic HCV infection have not been referred to specialty services or considered for treatment.7 Empowering primary care physicians to facilitate rapid work-up and treatment of the disease allows treatment to be offered in the community to individuals who are unable to readily access specialty services.
The purpose of this article is to provide a practical overview of the approach to and treatment of HCV infection within the community setting for primary care physicians.

Pre-treatment evaluation
The new DAA medications are associated with average cure rates of >90%. They are better tolerated, are orally administered and are more effective than previous therapies for HCV infection.8 As such, everyone living with chronic HCV infection should be considered for antiviral treatment, even if they have tried and failed interferon-based therapy in the past.
Prior to commencing DAA therapy, patients should undergo a thorough pre-treatment evaluation (Box 1). This should include identifying the genotype of hepatitis C involved, whether there is evidence of cirrhosis, and if treatment had been previously attempted. These factors directly influence the choice and duration of therapy. As compliance is a key component of treatment success, comorbid physical or psychological conditions should also be optimised before commencing therapy.
Box 1. Core concepts in the pre-treatment evaluation of patients with HCV infection

Is the patient infected with HCV? If so, what is the genotype?
  • HCV antibody positive indicates exposure
  • HCV viral load (PCR) indicates current infection
  • Hepatitis C genotype
Is there evidence of cirrhosis?
  • Physical examination: spider naevi, palmar erythema, gynaecomastia, splenomegaly
  • Biochemical tests: thrombocytopenia, low albumin, prolonged PT/ INR, aspartate aminotransferase-to-platelet ratio index >1.0
  • Imaging: ultrasonography or elastography (FibroScan)
Is the patient treatment naive or treatment experienced?
Do other medical conditions need optimisation first?
    • Patient has significant comorbidities or concurrent infections
    • Patient has prominent psychiatric issues that may interfere with medication compliance
    • Patient will soon be undergoing surgery that may make administration of medications more challenging
Do medication interactions need to be addressed?
      • Some antiepileptics, such as carbamazepine and phenytoin, are contraindicated, whereas others, such as sodium valproate and levetiracetam, are safe
      • Patient has prominent psychiatric issues that may interfere with medication compliance
      • Proton pump inhibitors may need to be taken at reduced doses and with the same administration time as certain antivirals (eg ledipasvir + sofosbuvir)
Does the patient need to be referred to a specialist for treatment?
  • Patients with cirrhosis, significant comorbidities or challenging drug–drug interactions should be referred

HCV, hepatitis C virus; INR, international normalised ratio; PCR, polymerase chain reaction; PT, prothrombin time

Table 1. Examples* of approved regimens for HCV under the Pharmaceutical Benefits Scheme6
Genotype 1Genotype 2Genotype 3Genotypes 4–6
Non-cirrhoticTreatment-naiveLedipasvir + sofosbuvir  
(8 or 12 weeks†)
Sofosbuvir + ribavirin
(12 weeks)
Daclatasvir + sofosbuvir  
(12 weeks)
Sofosbuvir +  PEG-IFN
+ ribavirin
(12 weeks)
Treatment-experiencedLedipasvir + sofosbuvir
(12 weeks)
Sofosbuvir + ribavirin
(12 weeks)
Daclatasvir + sofosbuvir  
(12 weeks)
Sofosbuvir +  PEG-IFN
+ ribavirin
(12 weeks)
CirrhoticTreatment-naiveLedipasvir + sofosbuvir
(12 weeks)
Sofosbuvir + ribavirin
(12 weeks)
Daclatasvir + sofosbuvir
(24 weeks)
Sofosbuvir +  PEG-IFN
+ ribavirin
(12 weeks)
Treatment-experiencedLedipasvir + sofosbuvir
(24 weeks)
Sofosbuvir + ribavirin
(12 weeks)
Daclatasvir + sofosbuvir
(24 weeks)
Sofosbuvir +  PEG-IFN
+ ribavirin
(12 weeks)
*A full list of approved regimens is available at www.pbs.gov.au/info/healthpro/explanatory-notes/general-statement-hep-c
Treatment for 8 weeks can be considered if pre-treatment HCV viral load is <6 million IU/mL
HCV, hepatitis C virus; PEG-IFN, peginterferon alfa-2a


Several groups of patients will require referral to a specialist for treatment, particularly those with current or prior evidence of decompensated cirrhosis, such as encephalopathy, previous variceal bleeding or refractory ascites.4 Regardless of the degree of compensation, individuals with cirrhosis will benefit from specialist review to assess readiness to commence therapy and assist with other aspects of care (eg variceal surveillance, hepatocellular carcinoma screening).

In cases where a diagnosis of cirrhosis is uncertain, referral for elastography (FibroScan) is the authors’ preferred method for establishing the degree of fibrosis. Thrombocytopenia, prolonged prothrombin time (PT)/international normalised ratio (INR) and hypoalbuminaemia are biochemical features that suggest the presence of cirrhosis. In the absence of elastography, a variety of other non-invasive tools, such as the aspartate aminotransferase-to-platelet ratio index (APRI) or Hepascore, can assist in establishing a diagnosis.9

Other patient groups that warrant closer specialist input are those in whom multiple comorbidities or concomitant medications make choosing the right regimen challenging. Many DAAs and their metabolites are renally cleared, and as such, their dosing in those with severe renal impairment (creatinine clearance <30 mL/min/1.73 m2) can be challenging. Other key considerations before commencing therapy are potential drug–drug interactions. Discontinuation of, or alternatives to, certain medications such as macrolide antibiotics, St John’s wort and certain antiepileptics, such as carbamazepine or phenytoin, is critical. The University of Liverpool drug–drug interaction checker (available online at www.hep-druginteractions.org) is a useful tool for ensuring there are no relevant drug–drug interactions.

Treatment
Six genotypes of hepatitis C have been identified, although genotypes 1 and 3 comprise 90% of all cases in Australia.10 An example of an approved treatment regimen for each genotype is listed in Table 1. Most of these regimens consist of once daily dosing; side effects of fatigue, headache, nausea and insomnia are uncommon and typically mild, and rarely necessitated cessation of the drug in clinical trials.11 In contrast to traditional interferon-based treatment regimes, intensive monitoring during therapy with DAAs is therefore seldom required. Nonetheless, it should be emphasised to patients that poor adherence to the daily dosing regimen can significantly affect response to therapy.
Treatment response is assessed 12 weeks after completion of therapy, with an assessment of hepatitis C viral load by polymerase chain reaction (PCR). Successful treatment is characterised by an undetectable level indicative of sustained virologic response (SVR). Although patients will remain positive for HCV antibodies, those who achieve SVR at 12 weeks should no longer be considered as being infected with the virus.12,13 However, it should be noted that positive serology is not a marker of protection, and repeat exposure may lead to reinfection.
Treatment of HCV is also an effective therapy for extrahepatic manifestations of hepatitis C such as cryoglobulinaemia and glomerulonephritis, and these should also demonstrate lasting improvement following treatment.11

Patients with normal liver function tests after SVR can be managed as if they had never been infected with HCV; however, high-risk behaviours should be addressed if present. Individuals with ongoing liver function test derangement, or those who have failed to achieve SVR, maintain a requirement for entry into surveillance programs and specialist involvement to pursue further therapeutic options.

Conclusion
Treatment of HCV infection should be considered for everyone in Australia who has a chronic infection. The relative scarcity of specialist services, compared with the prevalence of the disease, clearly suggests that treatment cannot be managed by specialists alone. Australia’s new model of care provides primary care physicians with streamlined access to highly effective and well-tolerated oral DAA therapy in consultation with experienced specialists. Furthermore, non-cirrhotic individuals with no significant comorbidities, concurrent infections or relevant drug–drug interactions rarely need to see these specialists in person to complete treatment.

Cure of chronic HCV infection has the potential to significantly improve the health of 230,000 Australians, decrease mortality from complications of chronic infection and reduce the burden of liver disease in Australia’s healthcare system.

Authors
Anthony Khoo MBBS, Basic Physician Trainee, Department of Medicine, Royal Adelaide Hospital, Adelaide, SA. anthony.khoo@sa.gov.au
Edmund Tse MBBS, PhD, FRACP, Head of Clinical Hepatology, Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA

Competing interests: Edmund Tse has received a grant from BMS for research into models of care and honoraria as an independent consultant on advisory boards for BMS/MSD/Gilead. He has been a speaker at a product launch presentation for BMS/Abbvie/Gilead.
Provenance and peer review: Not commissioned, externally peer reviewed.

References
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  8. Thompson AJ. Australian recommendations for the management of hepatitis C virus infection: A consensus statement. Med J Aust 2016;204(7):268–72. Search PubMed
  9. European Association for Study of Liver, Asociacion Latinoamericana para el Estudio del Higado. EASLALEH clinical practice guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015;63(1):237–64. Search PubMed
  10. McCaw R, Moaven L, Locarnini SA, Bowden DS. Hepatitis C virus genotypes in Australia. J Viral Hepat 1997;4(5):351–57. Search PubMed
  11. American Association of the Study of Liver Diseases, Infectious Diseases Society of America. HCV guidance: Recommendations for testing, managing, and treating hepatitis C. Virginia, VA: AASLD, IDSA, 2014. Available at www.hcvguidelines.org [Accessed 1 May 2016]. Search PubMed
  12. Yoshida EM, Sulkowski MS, Gane EJ. Concordance of sustained virological response 4, 12, and 24 weeks post-treatment with sofosbuvir containing regimens for hepatitis C virus. Hepatology 2015;61(1):41–45.    Search PubMed
  13. Swain MG, Lai MY, Shiffman ML, et al. A sustained virologic response is durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. Gastroenterology 2010;139(5):1593 Search PubMed

Friday, September 30, 2016

On eve of rollout, fears under-funding may restrict hep C treatment

Regular news from the New Zealand Doctor newsroom

On eve of rollout, fears under-funding may restrict hep C treatment
Cliff Taylorctaylor@nzdoctor.co.nz
Friday 30 September 2016, 3:20PM

The RNZCGP fears under-funding threatens a ground-breaking hepatitis C treatment even as GPs prepare to start prescribing it from tomorrow.

The college has written an urgent letter to the Ministry of Health saying it supports the treatment, but extensive GP input is needed and the cost “will have a significant impact on patient’s ability to obtain a cure”.

It is urging the ministry to consider funding options, including direct funding for free GP visits.

GPs have been preparing for three months for the rollout of Viekira Pak, shown in trials to cure more than 95 per cent of patients with hepatitis C genotype 1. The drug was financially out of reach for most people, until it was funded by Pharmac from 1 July.

Patients will be knocking on GPs’ doors

Pharmac and drug company Abbvie have been preparing GPs for the rollout with educational materials and seminars. Pharmac’s deputy medical director for primary care, GP Bryan Betty, says it is one of the biggest changes in general practice prescribing in decades.

Auckland liver specialist Ed Gane says GPs should expect to have patients “knocking on their door” from tomorrow.

“GPs need to ensure they are educated about this new treatment,” Professor Gane says in a media release. “This is our chance to offer a life-changing cure to many people living with hepatitis C.”

College endorses training but queries cost

RNZCGP chief executive Helen Morgan-Banda is in Australia today and unable to be interviewed. She sent an email saying the college is endorsing both face-to-face training via DHBs and an online module for GPs prescribing Viekira Pak. It is also promoting the training via its weekly e-newsletter to members.

Ms Morgan-Banda wrote to the ministry last Friday saying the college welcomes the new treatment as a great development that will have positive benefits for a large number of New Zealanders.

But she says the college is very concerned the cost of GP visits will present a barrier to patients. She suggested two alternative avenues for funding:

* direct funding for free visits, such as the ministry currently provides for dioxin exposed people, and

* funding through a DHB Primary Options for Acute Care (POAC) programme.

“Our view is that whichever model is deemed appropriate, action needs to be taken urgently to ensure that it is in place and funding is available as soon as possible after the 1 October date when access to treatment becomes available,” she wrote in the letter.

In today’s email, Ms Morgan-Banda says the medicines have been funded, but GP appointments have not. The college is concerned this will affect the success of the programme.

She says patients with hepatitis C tend to be more deprived than the general population and are also often transient. She is concerned the lack of funding will result in inequity of access to treatment.

New Zealand Doctor sought comment from the ministry, but did not receive a reply before deadline.

‘Game-changing’ – despite the cost

ProCare associate clinical director and GP Jamie Shepherd says the issue of cost has been discussed at the PHO and he understands why the college has concerns.

But he says he and colleagues are well prepared and excited about being able to offer the treatment.

“We would love to have it funded, but we recognise as a GP it’s our role to deliver this as best we can. We have been aware of the rollout since July. It will be a big change for general practice, but it’s been well highlighted.

“This is game-changing for people with hepatitis C in New Zealand.”

Huge improvement in treatment

Professor Gane is hailing the new drug’s efficacy. Viekira Pak is taken orally, usually for 12 weeks and will cure over 95 per cent of patients, he says. It is also well tolerated, with 99 per cent of people completing treatment.

“This is a huge improvement compared to previous Interferon treatments, which consisted of weekly injections for a year, associated with bad side effects. Almost 20 per cent of people had to stop the treatment and less than half were cured.”

However, he says an effective oral treatment is still needed for almost half of the New Zealanders infected with hepatitis C who have other genotypes (2, 3, 4, 5 and 6).

Buyers’ Club an option for some

He is calling for Pharmac to fund other pan-genotypic drugs, but says in the meantime personal importation of generic versions could be a viable option.

He says to date more than 500 New Zealanders and Australians have accessed generics through the Fix Hep C Buyers’ Club run by Australian GP James Freeman.
“The generic medications cured more than 95 per cent of patients and were extremely safe, proving that these generic drugs are the real deal,” Professor Gane says. “These medications cost less than five per cent of the price of brand drugs — which is about $2,100.”

Related link
October 1: a momentous day for many people living with hepatitis C in New Zealand - The Hepatitis Foundation of New Zealand

Wednesday, September 21, 2016

Hepatitis Australia - Pharmaceutical Benefits Advisory

First pan-genotypic, interferon-free regimens for hepatitis C a step closer
20 September 2016

Hepatitis Australia will be gathering information from people living with hepatitis C who will benefit from the latest medicines to be considered by the Pharmaceutical Benefits Advisory Committee. In particular we would like input from people living with hepatitis C genotypes 2, 3, 4, 5 and 6.

Hepatitis Australia will be making a submission and would welcome your input ahead of the November PBAC meeting.

The medicines being considered at the November meeting of PBAC include:
  • Sofosbuvir (400mg) + velpatasvir (100mg) – Epclusa® by Gilead Sciences
  • Ledipasvir (90mg) + sofosbuvir (400mg) – Harvoni® by Gilead Sciences
  • Paritaprevir (75mg) + ritonavir (50mg) + ombitasvir (12.5mg) – Technivie® by AbbVie
The most significant thing to note regarding these applications is that it heralds the first pan-genotypic, interferon-free regimens for hepatitis C. Epclusa is a new treatment for genotypes 1-6 and Gilead is also seeking to expand the use of Harvoni to other genotypes. Technivie is for the treatment of genotype 4.

Further details
Add your voice for the upcoming PBAC submission in November

Friday, August 26, 2016

Australia/Liver cancer time-bomb as up to 70% people with Hep C miss out on follow-up testing

Liver cancer time-bomb as up to 70% people with Hep C miss out on follow-up testing

Up to 70 per cent of Victorians with suspected hepatitis C may not have received follow-up testing, putting them at risk of chronic liver disease and even cancer, University of Melbourne researchers say.

Testing rates for the disease — which affects almost 10 times more Australians than HIV — were lowest among young people aged 15-24, representing a massive missed opportunity for treatment before the disease becomes serious, according to a paper in the Australian and New Zealand Journal of Public Health.

Lead author Kathryn Snow, of the University’s School of Population and Global Health, warned that liver cancer rates — which have tripled in Australia since 1982 — could spiral without a concerted effort to raise awareness of hepatitis C among GPs and people living with the disease.

Continue reading....

Monday, February 29, 2016

Australia - Hep C cures now as cheap as $6.20

Hep C cures now as cheap as $6.20

BY MARGARET SCHEIKOWSKI
MARCH 1, 2016 12:07AM

Breakthrough cheap hepatitis cures are now available to Australians, but many don't even know they have the deadly disease.

Some who do know are unaware of the four different medicines, subsidised by the federal government from March 1, which can cure without the terrible side-effects of previous therapies.

"The drugs themselves are fantastic but they are just a tool," Hepatitis Australia CEO Helen Tyrrell told AAP.

Hepatitis C 'cure' now affordable, but lack of awareness an obstacle

Hepatitis C 'cure' now affordable, but lack of awareness an obstacle

Simon Lauder reported this story on Monday, February 29, 2016 12:30:00

ELEANOR HALL: A new addition to the pharmaceutical benefits scheme is raising hopes of eradication for a deadly disease which affects 230,000 Australians.

A new generation of antiviral drugs has been found to cure Hepatitis C.

But until now, the drugs have been too expensive for most people to afford.

As Simon Lauder reports.

So we are talking about elimination within say a generation we hope to eliminate Hepatitis C.

SIMON LAUDER: But there's one major obstacle to that. Melanie Eagle says at the moment only about 2 per cent of Hepatitis C carriers seek treatment.

MELANIE EAGLE: We are talking deaths at the same rate as we are talking fatalities in cars.



Monday, February 22, 2016

Listen: Australia Hepatitis C treatment coming to PBS

Listen: Hepatitis C treatment coming to PBS

Monday 22 February 2016 5:50PM

Listen Now
Download

Monday 5.30pm
Repeated: Tuesday 5:30am
Presented by Dr Norman Swan
(view full episode)

Hepatitis C impacts 230,000 Australians.

A direct acting antiviral hepatitis C treatments will be available on the Pharmaceutical Benefits Scheme (PBS) from March 2016.

Australia are 18 months behind the U.S. roll out of this treatment - a result of the Australian government's protracted negotiations.

Hepatitis C is a chronic disease that can be cured – Helen Tyrrell, CEO of Hepatitis Australia, sees a possibility of it being eliminated in the next 15-20 years.