Showing posts with label HCV Awareness-screening strategies. Show all posts
Showing posts with label HCV Awareness-screening strategies. Show all posts

Monday, December 3, 2018

Millions flock to free tests as Egypt seeks to eradicate hepatitis C

Millions flock to free tests as Egypt seeks to eradicate hepatitis C
Mahmoud Mourad, Lena Masri
MIT NAMA (Reuters) - When Houaida Mabrouk heard about a government campaign that offers free hepatitis C screenings, she hesitated, afraid of testing positive. But after many from her community started visiting health clinics to get checked, she changed her mind.

“I thought, ‘I should go too’,” Mabrouk said, speaking at a clinic in the Mit Nama village near Cairo before learning she did not have the virus.

Egypt, which has the highest rate of hepatitis C in the world, is carrying out an unprecedented campaign to detect and treat the disease in a bid to eliminate it by 2022. It aims to test the entire adult population — about 50 million people.

Thursday, November 29, 2018

Hepatitis C Screening And New Treatments Allow Baby Boomers To Escape “The Kiss of Death”

Hepatitis C Screening And New Treatments Allow Baby Boomers To Escape “The Kiss of Death”
By Katherine O'Brien
November 29, 2018 
Finding out you have stage 3 hepatitis C (HCV) might not be most people’s idea of luck, but Ron Shean feels fortunate. Despite the damage to his liver, his disease was caught before it progressed to cancer.

Shean, who had planned to donate a kidney to his uncle, found out about his condition from the Kidney Foundation. “I got so lucky [that] I backed right into it,” says the 62 year old, who surmises that his “demise would have come sooner than expected” had the foundation not asked him for bloodwork.

When he first heard the news, though, Shean felt more devastated than grateful. “The only thing I’d heard about hep C was that it was referred to as ‘the kiss of death’ so there’s a bit of shock that comes with that,” he says.
Read more:

Wednesday, November 21, 2018

HCV epidemic continues to rise among young adults

Of Interest 
AASLD 2018 The Liver Meeting®:
“Our data demonstrate that people who inject drugs can achieve SVR at comparable rates to non-drug using populations, even if adherence is imperfect,”

We Cured Hepatitis C - Now The Work Begins: Finding Neglected Patients  
One Health System's Efforts to Eliminate Hepatitis C

Real-World Data Show Rising HCV Epidemic Among Young Adults
Cassandra Pardini, PharmD
Results from the largest real-world study analyzing hepatitis C virus (HCV) screening practices determined that, although HCV antibody (AB) screening and confirmatory RNA testing rates are improving, the HCV epidemic continues to rise among young adults.

The study included 17,149,480 patients obtained from 2 national laboratory datasets who were screened between 2013 and 2016 based on an AB test. The study authors defined an active HCV infection as having an HCV RNA+ result following a positive AB test. The study authors added, "AB screening rates, AB+ rates, RNA follow-up testing rates, and RNA+ rates were assessed descriptively by year and stratified by baby boomers 48-71 years old and young adults 18-39 years old, to reflect the evolving disease epidemiology."

Reference: Abstract
Sulkowski MS, Marx S, Manthena SR, Strezewski J, Chirikov VV. National Estimates for HCV Screening and Diagnosis Rates in the United States (2013-2016) Based on Large Real-World Dataset. Presented at AASLD The Liver Meeting 2018. Study number 1565.

Full-Text Article
First published: 6 November 2018 - In Hepatology

Monday, November 19, 2018

Targeted Hepatitis C testing misses substantial number of cases in correctional setting

Targeted Hepatitis C testing misses substantial number of cases in correctional setting

Researchers recommend routine testing for all incarcerated individuals upon arrival

Results from a new study led by Boston Medical Center (BMC) found routine Hepatitis C testing identified a significant number of cases that would have been missed by targeted testing among a population of individuals in Washington State prisons. Published in the American Journal of Preventive Medicine, the authors recommend routine testing in correctional facilities to best identify and treat the disease as part of the national strategy to eliminate Hepatitis C transmission.

It is estimated that 30 percent of the total Hepatitis C (HCV) infected population in the United States passes through the prison system annually, yet there is no widely accepted approach to HCV testing in correctional settings. Approximately 40 percent of state prison facilities, including Washington State, routinely test for HCV. Other facilities employ the Centers for Disease Control and Prevention (CDC) recommendation of targeted or risk-based testing, which tests individuals born between 1945 and 1965 as well as those with a history of injection drug use.

Researchers looked at data from Washington State prison HCV testing results to determine whether routine or targeted testing was most effective in identifying cases of disease. From 2012 to 2016, more than 24,000 people were tested for HCV; 20 percent of those people were infected and close to 2,000 people had chronic infections. Of those with chronic infections, nearly a quarter had at least moderate liver disease, putting them at risk for complications.

Infections were more prevalent in individuals born between 1945 and 1965, however nearly 35 percent of infections would have been missed if only targeted testing was performed. With routine testing, five individuals had to be tested to identify a case of HCV, compared to three individuals with targeted testing. This remains a small number in contrast with other infectious diseases, such as HIV, that require testing a large number of incarcerated individuals to identify a single case.

"These data build upon existing evidence supporting the implementation of routine testing for all individuals when entering a correctional facility," said Sabrina Assoumou, MD, MPH, an infectious diseases physician at BMC and lead author of the study. "Coupled with treatment, routine testing would identify and cure many cases of HCV, preventing the substantial burden of future liver disease."

One of the current barriers to routine testing is the high cost of HCV treatment. Even without treatment, those who receive a diagnosis of HCV may make lifestyle changes that can reduce transmission.

Researchers also note that it is unclear how these findings will generalize to other U.S. prison populations, and believe more research should be done to determine the effectiveness of routine HCV testing across the country. 

Journal American Journal of Preventative Medicine
https://www.eurekalert.org/pub_releases/2018-11/bmc-thc111918.php

Wednesday, November 14, 2018

Hepatitis C in the UK – the path to elimination

Rachel Halford
Chief Executive
The Hepatitis C Trust
Tweet @HepatitisCTrust
www.hepctrust.org.uk

Hepatitis C in the UK – the path to elimination

14th November 2018
Following an 11% fall in hepatitis C-related deaths between 2016 and 2017, Rachel Halford makes the case for a national strategy to eliminate hepatitis C in the UK.

In May 2016, the UK joined 193 other countries in committing to eliminate viral hepatitis C globally by 2030, as part of the World Health Organization’s Global Health Sector Strategy on Viral Hepatitis. This commitment marked a watershed moment in the fight against hepatitis C, a blood-borne virus which primarily affects the liver. Earlier this year, NHS England went even further and announced a target of elimination of hepatitis C in the UK by 2025.

Globally, it is estimated that 71 million people are infected with chronic hepatitis C, including around 210,000 in the UK. Hepatitis C disproportionately affects disadvantaged and marginalised communities in the UK, including injecting drug users, homeless people, prisoners and certain migrant communities.
Opportunities and challenges in the fight against hepatitis C in the UK

To monitor the UK’s progress towards eliminating hepatitis C as a major public health threat, Public Health England produces an annual ‘Hepatitis C in the UK’ report. The latest edition, released in August 2018, highlighted some positive developments, with an 11% fall in hepatitis C-related deaths between 2016 and 2017, following on from a 3% fall in deaths the previous year. More people are accessing treatment for hepatitis C in the UK than ever before, with 14,348 accessing treatment in the UK in 2017/18, more than double pre-2015 levels.

This encouraging progress follows the arrival in 2014 of the new direct acting antiviral (DAA) treatments for hepatitis C, which offer a significant improvement on the old, interferon-based treatments. Whereas the old treatments required a course of injections over a 48-week period and had significant side effects and low cure rates, the new DAA treatments are taken orally for 8-12 weeks, have very few side effects and cure around 95% of patients.

The new treatments have revolutionised hepatitis C care, making treatment both more effective and accessible.

However, in other regards the 2018 ‘Hepatitis C in the UK’ report made less encouraging reading. The report revealed no significant reduction in overall prevalence of hepatitis C or in numbers of new infections, which suggests that the WHO target of reducing new cases of chronic hepatitis C by 30% by 2020 and 80% by 2030 represents a significant challenge for UK hepatitis C prevention and treatment services

In addition to the lack of progress in reducing prevalence and incidence rates, it is estimated that around 40-50% of those infected with chronic hepatitis C in the UK remain undiagnosed. As the ‘Hepatitis C in the UK’ report notes, meeting the WHO goal of a 65% reduction in mortality from hepatitis C depends on sustaining the current improvements in the numbers of people accessing treatment, which in turn is dependent on capacity to find and treat those who remain undiagnosed, and to re-engage those diagnosed but not treated.

Addressing these ongoing issues will require a range of actions, and it is The Hepatitis C Trust’s view that a comprehensive, written national hepatitis C elimination strategy is needed to co-ordinate the various actors and actions needed to achieve elimination by 2030 at the latest, a view shared by the All-Party Parliamentary Group on Liver Health, leading clinicians, patient organisations and industry. Such a strategy should cover the approach to raising awareness of hepatitis C, preventing new infections, and increasing testing and treatment rates, with some of the key issues that must be addressed outlined below.
We must boost awareness

It is vital that awareness of hepatitis C transmission risks is increased among at-risk groups and the wider public. A government-led awareness campaign, comparable to the approach taken to HIV in the 1980s, could help to raise awareness of hepatitis C among the general public. The use of peer programmes, whereby former patients deliver talks and provide support to those with a background similar to their own, are a particularly effective way of increasing awareness among at-risk groups, and The Hepatitis C Trust is actively involved in delivering peer support in substance misuse services and prisons. Increasing awareness of hepatitis C transmission risks is a vital tool in both preventing new infections and finding undiagnosed patients.

As well as increasing awareness among at-risk groups and the wider public, more needs to be done to increase knowledge of hepatitis C among healthcare professionals. The Hepatitis C Trust’s helpline still too often hears stories of patients going years without being diagnosed, despite presenting to their GP with symptoms that should have led to the offer of a hepatitis C test. To support efforts to increase awareness of hepatitis C among key healthcare professionals, The Hepatitis C Trust co-ordinates HCV Action, a network for hepatitis C professionals, which holds roadshows and public health meetings, produces resources and circulates examples of best practice. However, other measures could help to further support professional knowledge of hepatitis C, such as the circulation of key hepatitis C-related information and resources by Public Health England and clinical commissioning groups and ongoing hepatitis C training opportunities for healthcare professionals.
We must strengthen prevention efforts

Preventing new infections of hepatitis C is also key to achieving the elimination goal. Whilst increased awareness of hepatitis C transmission risks can support prevention efforts, there is also a need for greater harm reduction services for those at risk. For example, the provision of sterilised injecting equipment and support transitioning to opioid substitution treatment (OST) is crucial in reducing transmission between injecting drug users, which accounts for around 95% of new hepatitis C infections in the UK. With the 2018 ‘Hepatitis C in the UK’ report highlighting suboptimal provision of clean injecting equipment across the UK, a greater emphasis on harm reduction is key to preventing new infections and must be supported in the commissioning and funding of services for injecting drug users.

Innovative approaches to preventing new infections should also be explored. Drug consumption rooms, for example, offer the opportunity to support injecting drug users with harm reduction and have been successfully implemented in a number of European countries. Another innovative prevention strategy is the ‘treatment as prevention’ approach, which involves treating large numbers of actively injecting drug users and others still engaged in risky behaviours to halt further transmissions. This approach is currently being trialled by NHS Tayside in Scotland, with models indicating that a reduction of hepatitis C among those injecting drugs from over 30% to below 10% would result in a corresponding decline in transmission from 10% to below 1%, leading to effective elimination of the virus. Should such an approach be proved to be effective, it should be implemented across the UK.
We must improve and prioritise testing and diagnosis

A rapid expansion of testing will also be needed to ensure sufficient numbers of patients are diagnosed and enrolled into treatment. There are a number of measures that can be taken to improve the approach to testing in key settings. For example, ‘opt-out’ testing of clients should be introduced in substance misuse services, with monitoring systems and targets for test offers and uptake included in commissioning contracts. In prisons, another high-prevalence setting, an opt-out testing policy is already in place, but more needs to be done to ensure effective implementation, including guidance and training for prison healthcare teams. Just as importantly, re-testing must take place regularly in high-prevalence settings, to ensure new infections are picked up.

There are a number of other settings in which hepatitis C testing should be prioritised, including pharmacies, homeless hostels, mosques and A&E departments. Pharmacies are a particularly important setting, with many current or former injecting drug users accessing them to collect clean needle and syringes or OST. Interim results from an ongoing pilot project by the London Joint Working Group on Substance Use and Hepatitis C have shown community pharmacies to be an effective setting for finding those with an undiagnosed infection of hepatitis C, with results from the first six weeks of testing in six London pharmacies showing a 50% hepatitis C antibody positive rate among those tested, with 47% of these previously undiagnosed.
We must expand access to treatment

As the ‘Hepatitis C in the UK’ report notes, achieving the WHO target of a 65% reduction in hepatitis C deaths by 2030 will depend upon sustaining current improvements in numbers accessing treatment. With most patients in touch with services having now been treated, there is a pressing need to find undiagnosed patients so that they can receive treatment. In support of its target of elimination by 2025, NHS England is currently engaged in negotiations with industry to agree a new funding approach to hepatitis C treatments. If agreed, such a deal is expected to cap the cost of treatments to the NHS above a certain threshold and include a role for industry in case finding. This is a positive step, but The Hepatitis C Trust believes that there must be central co-ordination to ensure a strategic and equitable approach to case finding and treatment.

Engaging more patients in treatment will also require treatment to be made available in settings most convenient to patients. Making treatment available in community settings such as pharmacies, substance misuse services, sexual health clinics, homeless hostels and GP surgeries supports patients to engage with treatment and can be particularly beneficial for patients who traditionally have difficulty accessing secondary care services.

Elimination is possible, but more action is needed

Considerable progress has been made in relation to hepatitis C in recent years. Achieving elimination by 2030 (or even by 2025) is feasible, but it will require the mobilisation and co-ordination of a range of actors. Despite this, the government maintains that it has no plans to publish an elimination strategy. With the prospect of a new funding deal offering the opportunity to treat many more patients, it essential that a national strategy is developed and implemented to ensure the opportunity to eliminate hepatitis C as a public health threat in the UK is seized.

Rachel Halford
Chief Executive
The Hepatitis C Trust
Tweet @HepatitisCTrust
www.hepctrust.org.uk

Friday, November 9, 2018

Universal HCV Screening on the Way?

Gastroenterology > Hepatitis 

Universal HCV Screening on the Way?
Move afoot to recommend testing for everyone regardless of perceived risk
by Sony Salzman, Contributing Writer, MedPage Today
November 09, 2018
Hepatitis C virus (HCV) is the most common bloodborne infection in the United States. In 2014, it killed more Americans than any other infectious disease. Rates of acute hepatitis C quadrupled from 2010 to 2016.  Yet despite the high prevalence of HCV, the CDC estimates that about half of people living with the virus don't know they're infected...
Read the article: 
https://www.medpagetoday.com/gastroenterology/hepatitis/76227

The Liver Meeting®
Universal Hepatitis C Screening of Pregnant Women More Cost-Effective Than Risk-Based Approach
November 9, 2018
Data from a new study presented this week at The Liver Meeting® found that universal screening of pregnant women at risk for hepatitis C virus (commonly called HCV) infection is a more efficient and cost-effective diagnostic approach than risk-based screening.
Read the press release.
On This Blog
Tuesday, November 6, 2018 
Over 2 Million Americans Have Hepatitis C; Affects nearly every generation 
Hepatitis C now poses a serious health threat to three generations of Americans, all of whom need to be reached with prevention services, testing, and treatment:
Baby boomers (born between 1945 and 1965) account for a large portion of all chronic hepatitis C infections in the United States and currently have the highest rate of hepatitis C-related deaths. CDC recommends that all adults born between 1945 and 1965 get a one-time test for hepatitis C, but only a small fraction have done so.
Adults under 40 have the highest rate of new infections, largely because of the opioid crisis.

Infants born to mothers with hepatitis C are a growing concern. The overall risk of an HCV-infected mother transmitting infection to her infant is approximately 4 percent to 7 percent per pregnancy. From 2011 through 2014, national laboratory data indicate that the rate of infants born to women living with hepatitis C increased by 68 percent. 
Read More:

Climbing Hepatitis C Rates Underscore Needs for Integrated Care, Increased Resources
Nov 6, 2018
Data showing a tripling of hepatitis C cases across America during the last decade highlight urgent and multi-faceted public health needs for expanded access to prevention, screening and treatment in addition to integrated health services that provide care for substance use disorders and associated infectious diseases.

Showing that more than four million adults have evidence of past or current hepatitis C infection, and that nearly two and a half million people in the U.S. are living with the virus now, the data, released today by the U.S. Centers for Disease Control and Prevention, also indicate that half of those infected do not know it.

And, although direct-acting antiviral medicines can now cure most people living with hepatitis C, the majority of those infected have not accessed the treatment. The data show that the consequences of ongoing, undiagnosed and untreated hepatitis C have multi-generational impacts, with most new infections occurring among young adults in 2016, and increasing numbers of infants born to women with the virus, exposed to as much as a seven percent chance of also becoming infected.

The data demand substantial investments in CDC programs carrying out surveillance and providing screening and diagnosis and linkage to treatment. Improved access to, and Medicaid coverage of direct-acting antivirals, for all patients who need them, is essential. In addition, the data highlight impacts of the opioid crisis that will require a large scale up of integrated prevention, treatment and care efforts. The need for innovative models of care for addiction and related infectious diseases, including hepatitis C, is critical, as is investment in the expert workforce to care for these patients. The Infectious Diseases Society of America and the HIV Medicine Association have advocated for robust public health funding to boost surveillance, prevention measures that include syringe exchange services, provider training and care coordination and will continue to call for strong Congressional support and evidence-based action to reduce HCV transmission and expand access to curative HCV treatment.

The tools to eliminate hepatitis C exist, but this goal can only be reached with the support and resources that will be needed to identify all infected individuals, connect them with treatment and prevent new infections.
https://www.idsociety.org/news--publications-new/articles/2018/climbing-hepatitis-c-rates-underscore-needs-for-integrated-care-increased-resources/

Monday, October 29, 2018

What's Up Doc?: Hepatitis C, a killer that can be stopped

What's Up Doc?: Hepatitis C, a killer that can be stopped
By Dr. Malavika Varma with Dr. Aravind Ganesh
Hepatitis C (HepC) is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver. The virus can cause both acute (rapid onset) and chronic (long-term) symptoms. Symptoms include a fever, dark urine, abdominal pain, and yellow tinged skin (“jaundice”). Hepatitis C can often lead to liver disease and occasionally cirrhosis. In some cases, it can cause complications such as liver failure, hepatocellular carcinoma (liver cancer), and death.

Read the article: 
https://www.thewhig.com/health/family-child/whats-up-doc-hepatitis-c-a-killer-that-can-be-stopped/wcm/b4b41a2b-2a07-4d3b-8e83-b0797daebd0e

What’s Up, Doc? is a medical column that covers the most interesting doctors, health researchers, and health-care issues or innovations in Canada and in our wider global community.

Wednesday, October 17, 2018

UC researchers support universal screening to tackle rise in hepatitis C

Recommended Reading
At-Risk Teens and Young Adults Overlooked During Opioid Crisis Too Few Tested for Hepatitis C, Research Suggests
SAN FRANCISCO – Teens and young adults who have injected drugs are at risk for contracting hepatitis C, but most aren’t tested and therefore don’t receive life-saving treatment, according to a national study being presented at IDWeek 2018. The study of more than 250,000 at-risk youth found only one-third of those with diagnosed opioid use disorder (OUD) were tested for hepatitis C...
Read more...

UC researchers support universal screening to tackle rise in hepatitis C 
Physicians are encountering a growing number of younger patients who are testing positive for hepatitis C virus (HCV) fueled largely by the opioid crisis impacting communities around the country. That increase and more effective and tolerable drug regimens for HCV infection, means one-time universal screening of all adults for HCV is now cost effective and recommended, say physician researchers in the University of Cincinnati (UC) College of Medicine.

The researchers used a computerized Markov state transition model to estimate the impact of one-time universal screening of adults 18 years of age and older compared either with no screening at all or with the current guideline-based strategy of largely screening baby boomers—adults born between 1945 and 1965—for HCV, says Mark Eckman, MD, Posey Professor of Clinical Medicine and Director of UC Division of General Internal Medicine.

They measured effectiveness with quality-adjusted life years (QALYs)—that’s the gain of in life expectancy adjusted for the quality of life—and costs from the health system perspective in 2017 U.S. dollars, says Eckman, lead author of the study and a UC Health physician. Universal screening followed by guideline-based treatment of all those with chronic HCV infection has an incremental cost effectiveness ratio of $11,378 per quality-adjusted life year compared with birth cohort-based screening alone.

"Most health economists consider anything less than $50,000 per quality-adjusted life year to be highly cost-effective,” says Eckman.

The results of the study are available online in the scholarly journal Clinical Gastroenterology and Hepatology.

The Centers for Disease Control and Prevention (CDC) estimates 2.7 million individuals in the U.S. have chronic HCV infection with 81 percent of that group consisting of baby boomer adults. In 2011, in addition to testing individuals at high risk due to intravenous drug use or other possible exposures to HCV, the CDC recommended one-time testing for the baby boomer cohort. That recommendation was later endorsed by the U.S. Preventive Services Task Force.

But since then the face and treatment of hepatitis C has changed.

"So what happened to make it reasonable to screen a wider population for HCV?” asks Eckman. "The incidence of hepatitis C among younger drug-injecting patients is skyrocketing so we have a blip in HCV cases that’s no longer isolated to the baby boomer cohort.

"We are also now in an era of HCV treatments that are more effective than even five or six years ago. Furthermore, these new regimens are easier to tolerate, have fewer severe side effects and require a short period of treatment,” says Eckman.

"All these factors coming together are what drove the model to show that screening a broader population than just the baby boomer cohort is effective,” says Eckman.

The baby boomer generation came of age during a time of experimentation, and many individuals who may have tried injectable drugs, even once, and never thought of themselves as having a problem, may be infected with the hepatitis C virus, says Eckman. "While these silent cases have been hanging out for decades what has changed recently is the new epidemic of hepatitis C in younger patients related to drug use,” he says.

Eckman says the cost to treat HCV can range from $9,000 to $30,000 per month depending on the medications being used, and that many health insurance plans, including Medicare Part D and most Medicaid plans cover the costs of treatment. For individuals without health insurance, treatment may remain a challenge, he adds.

Eckman says the U.S. Preventive Services Task Force is currently reviewing and updating guidelines for hepatitis C and it’s possible a broadening of the current screening recommendations may occur.

"Early diagnosis and treatment of hepatitis C infection prevents development of progressive liver disease, and reduces long-term risk of cirrhosis, liver cancer and other HCV-associated health problems”, says study co-author and liver expert, Kenneth Sherman, MD, PhD, Gould Professor of Medicine and Director in the UC Division of Digestive Diseases.


John Ward, MD from the Task Force for Global Health and the Centers for Disease Control and Prevention is also a co-author of the study. Funding for the study came from the CDC Foundation along with support coming from multiple donors to the CDC Foundation’s Viral Hepatitis Action Coalition.

Sherman has grants/contracts (institutional funding) from AbbVie, Bristol-Myers Squibb, Gilead, Inovio, Intercept, MedImmune, and Merck, and serves on advisory boards for Abbott Laboratories, Gilead, MedImmune, Merck, and Inovio. Sherman also serves on safety monitoring boards for Watermark and MedPace. Eckman has grant support from Merck through the Merck Investigator Studies Program.

Wednesday, September 19, 2018

Expand Screening for HCV infection in all adults living in the US?

MEDPAGE TODAY
Gastroenterology > Hepatitis 
Time to Expand Age Base for HCV Screening? 
Bargain price of $11,378 per QALY gained for one-time, universal testing
by Diana Swift, Contributing Writer September 15, 2018

Compared with currently recommended birth cohort screening, universal one-time screening for hepatitis C virus (HCV) for U.S. adults would be highly cost-effective, resulting in an expenditure of $11,378 per quality-adjusted life year (QALY) gained, researchers reported

The findings support broadening the current age cohort for one-time screening to all U.S. adults, concluded Mark H. Eckman, MD, of the University of Cincinnati, and colleagues. "A recommendation for HCV testing of all adults will support the national response to the epidemic of HCV infection among young persons in the United States."

Continue reading:

Primary Source
Clinical Gastroenterology and Hepatology

Wednesday, August 29, 2018

Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care

Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care
Rachel L. Epstein, MD, Vishakha Sabharwal, MBBS, Elisha M. Wachman, MD,
Kelley A. Saia, MD, Claudia Vellozzi, MD, MPH, Susan Hariri, PhD, Benjamin P. Linas, MD, MPH

DOI: https://doi.org/10.1016/j.jpeds.2018.07.006

Complete article shared by @HenryEChang via twitter


Objectives
The US National Viral Hepatitis Action Plan calls for major efforts to expand hepatitis C virus (HCV) diagnosis and treatment; prenatal care settings are potential venues for expanding HCV testing. We aimed to characterize the HCV diagnostic cascade for women and infants and investigate factors associated with linkage and follow-up.

Study design
We used electronic health records for a 10-year cohort of 879 women with opioid use disorder from an obstetric clinic serving women with substance use disorders.

Results
Altogether, 744 women (85%) were screened for HCV; 510 (68%) were seropositive, of whom 369 (72%) had nucleic acid testing performed and of these 261 (71%) were viremic. Of 404 infants born to HCV-seropositive women, 273 (68%) were tested at least once for HCV, 180 (45%) completed the American Academy of Pediatrics-recommended perinatal HCV screening, and 5 (2.8%) were diagnosed with HCV infection and linked to care. More recent delivery date (2014-2015) was associated with maternal linkage to care (aOR, 2.5; 95% CI, 1.4-4.7). Maternal coinfection with HIV (aOR, 9.0; 95% CI, 1.1-72.8) and methadone maintenance therapy, compared with buprenorphine (aOR, 1.5; 95% CI, 0.9-2.5), were associated with higher rates of infant HCV testing.

Conclusions
HCV prevalence among pregnant women with opioid use is high and infant HCV screening is imperfect. Programmatic changes to improve both mother and infant follow-up may help to bridge identified gaps in the cascade to cure.

Sunday, July 1, 2018

Cost-effective universal screening for hepatitis C in France

Cost-effective universal screening for hepatitis C in France
It is currently recommended in Europe that screening for hepatitis C virus (HCV) should target people at high risk of infection. In France, public health data suggest that in 2014 approximately 75 000 people aged 18 to 80 were infected by HCV, but were unaware of their status. In at least one in ten cases, these people are at an advanced stage of the disease when diagnosed. Today's treatments of HCV infection are both highly effective and well tolerated, and cure the infection in a few weeks in over 95% of cases. In Professor Yazdan Yazdanpanah's Inserm research team, Sylvie Deuffic-Burban has developed a mathematical model that assesses the efficacy and cost-effectiveness of different screening strategies, including universal screening.

This study applied data from a 2004 InVS seroprevalence survey to 18- to 80-year-olds in France, excluding people with diagnosed chronic HCV infection. The researchers developed their analytical model using a combination of these seroprevalence data and findings from studies of the characteristics of people infected (age, sex, stage of the disease at diagnosis, alcohol intake, etc.), the natural progression of the disease, the efficacy of treatments, the quality of life of the patients treated, and the cost of treatment of infection. The screening strategies assessed targeted the following groups: the at-risk population only, all men aged between 18 and 59, all people aged between 40 and 59, all people aged between 40 and 80, and everyone aged between 18 and 80, ie, universal screening.

The modeling results show that universal screening is associated with better life expectancy adjusted for quality of life than other strategies. Universal screening is cost-effective if the patients tested for HCV infection are treated rapidly after diagnosis. Sylvie Deuffic-Burban points out that "Screening, on an individual basis, enables rapid treatment, which avoids the development of serious complications. In time, collective screening helps eliminate hepatitis C from a population that has been screened without restrictions." The results of this ANRS-funded study therefore argue in favor of universal screening for HCV in France, followed by immediate treatment of those diagnosed with HCV infection. Sylvie Deuffic-Burban concludes that "Although our model is unable to test the idea, the epidemiological similarities of HCV, HIV, and HBV suggest that universal and combined screening for these three viruses could be of particular interest."

Sources: Research Article
Assessing the cost-effectiveness of hepatitis C screening strategies in France
Sylvie Deuffic-Burban, Alexandre Huneau, Adeline Verleene, Cécile Brouard, Josiane Pillonel, Yann Le Strat, Sabrina Cossais, Françoise Roudot-Thoraval, Valérie Canva, Philippe Mathurin, Daniel Dhumeaux, Yazdan Yazdanpanah
DOI: https://doi.org/10.1016/j.jhep.2018.05.027
Publication stage: In Press Corrected Proof
Published online: July 1, 2018

Article Source

Thursday, June 21, 2018

60,000 adults in the UK have cirrhosis, nearly 75% percent don't know it


7 in 10 people with liver disease in the UK don’t even know they have it 
Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Although over 60,000 adults in the UK have cirrhosis (scarring) of the liver, nearly 75% percent don't know it, according to research published in the Lancet. For many, the first indication is following admission to Accident and Emergency when the disease is advanced and chance of survival is very low. This week, 18th to 24th June, is Love Your Liver week, and the British Liver Trust has launched a new version of an online screening tool so that people can find out if they are at risk.

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

The British Liver Trust’s Love Your Liver campaign focuses on three simple steps to Love Your Liver back to health:

- Drink within recommended limits and have three consecutive alcohol-free days every week
- Cut down on sugar, carbohydrates and fat and take more exercise
- Know the risk factors for viral hepatitis and get tested or vaccinated if at risk

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Liver disease is one of the leading causes of premature death in England and is responsible for more than 1 in 10 deaths of people in their 40s.

Professor Nick Sheron, a liver expert from the University of Southampton involved in the research, said: "Liver disease develops silently with no signs or symptoms and is the second leading cause of years or working life lost. If current trends continue it become the leading cause of premature mortality in the UK. Yet, most people with fatal advanced liver disease only become aware that they have a liver problem when they are admitted as an emergency. We MUST diagnose these people much earlier."

Liver problems develop silently with no obvious symptoms in the early stages yet the disease is largely preventable through lifestyle changes. The Love Your Liver awareness campaign, promoted by the British Liver Trust, aims to reach the one in five people in the UK who may have the early stages of liver disease, but are unaware of it.

More than 90% of liver disease is due to three main risk factors: obesity, alcohol and viral hepatitis.

Judi Rhys, Chief Executive, British Liver Trust said, “Helping people understand how to reduce their risk of liver damage is vital to address the increase in deaths from liver disease. Although the liver is remarkably resilient, if left too late damage is often irreversible. I would urge everyone to take our online screener on our website to see if they are at risk.”

Finding out your risk of liver disease only takes a few minutes. It could be the most important thing you do today. Take the British Liver Trust’s screener here

Monday, June 4, 2018

Updated Guidelines - Hepatitis C testing recommended for Canadians born between 1945 and 1975

Podcast
In this podcast, Dr. Hemant Shah and Dr. Jordan Feld discuss a clinical practice guideline from the Canadian Association for the Study of the Liver on the management of chronic hepatitis C. The guideline is published in the Canadian Medical Association Journal (CMAJ).


CMAJ Vol. 190, Issue 22 4 Jun 2018
The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver
Hemant Shah, Marc Bilodeau, Kelly W. Burak, Curtis Cooper, Marina Klein, Alnoor Ramji, Dan Smyth and Jordan J. Feld; for the Canadian Association for the Study of the Liver
CMAJ June 04, 2018 190 (22) E677-E687; DOI: https://doi.org/10.1503/cmaj.170453

A recent modelling study suggested that about 252 000 Canadians (uncertainty interval: 178 000–315 000 Canadians) were chronically infected in 2013. The birth cohort of 1945–1975 has the highest prevalence of chronic HCV infection, yet it is estimated that up to 70% of this group have not been tested for HCV 

KEY POINTS
Hepatitis C is a major public health problem in Canada that is underdiagnosed and undertreated; birth cohort screening would benefit population health outcomes.

Pretreatment evaluation of an infected patient should include clinical evaluation, viral load, genotype and a fibrosis stage assessment.

The treatment of hepatitis C has become safer, better tolerated and more effective owing to the availability of direct-acting antivirals for nearly all patients; this guideline advocates against the use of any interferon-based treatment regimens and for the use of all-oral regimens for all infected patients.

The treatment of infected patients should be individualized to maximize chance of success, especially for difficult-to-cure populations, including patients with renal failure, decompensated cirrhosis, and active substance use disorders.

After treatment, the follow-up of successfully treated patients depends on whether they are cirrhotic; patients with cirrhosis require life-long surveillance for the development of hepatocellular cancer.

Chronic hepatitis C virus (HCV) is a highly burdensome public health problem in Canada, causing more years of life lost than any other infectious disease in the country. 13 A recent modelling study suggested that about 252 000 Canadians (uncertainty interval: 178 000–315 000 Canadians) were chronically infected in 2013. The birth cohort of 1945–1975 has the highest prevalence of chronic HCV infection, yet it is estimated that up to 70% of this group have not been tested for HCV.4

Although the overall prevalence of chronic hepatitis C is declining, complications of the disease are increasing because of aging of the infected population and progression of liver fibrosis.13 Modelling data suggest that if nothing is done to change the current situation, cases of decompensated cirrhosis, hepatocellular carcinoma and liver-related mortality will increase by 80%, 205% and 160%, respectively, by 2035 compared with 2013 levels.2

The primary objective of anti-HCV therapy is complete eradication of the virus, termed a sustained virologic response, which is defined as absence of viremia 12 weeks after completion of therapy. 5 Once achieved, sustained virologic response is considered a true cure of the viral infection, as late relapses are very uncommon. 6,7 Sustained virologic response is associated with long-term health benefits that include improved quality of life8,9 and liver histology, 10,11 and reduced incidence of hepatocellular carcinoma,12 liver-related morbidity and mortality,1315 and all-cause mortality.12

Since the last Canadian guideline on the management of chronic HCV infection from the Canadian Association for the Study of the Liver was published in 2015,16 there have been remarkable treatment advances. Thus, there was a need for an updated, evidence-based guideline.
Continue reading: http://www.cmaj.ca/content/190/22/E677

In The News
Hepatitis C testing recommended for Canadians born between 1945 and 1975
More than 250,000 Canadians are believed to be infected with hepatitis C, but 40 to 70 per cent are unaware they harbour the blood-borne virus. The Canadian Association for the Study of the Liver, a national group of health-care providers and researchers, published its guidelines on testing and treating hepatitis C in Monday’s edition of the Canadian Medical Association Journal.
Continue reading: http://nationalpost.com/news/canada/hepatitis-c-testing-recommended-for-canadians-born-between-1945-and-1975

Saturday, May 26, 2018

Weekend Video: HCV From Screening to Cure - Hosted By Ira M. Jacobson, MD.

Good day folks, the following video presentation; "HCV From Screening to Cure: A Closer Look at Changing At-Risk Populations and an Evolving Treatment Landscape" with Ira M. Jacobson, MD., and provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education, is now available for your viewing pleasure.

In this learning activity the good doctor will discuss screening strategies, stigma, patient-related barriers to treatment, hepatitis C testing for identifying current infection, and tests used to stage fibrosis. Also discussed is treatment for HCV patients with cirrhosis, as well as treatment adherence, duration, treatment according to HCV genotype, ending with "How Much Care Do The Cured Need?"

Although the learning activity is aimed at HCV specialists, this short patient-friendly presentation is beneficial for anyone considering HCV testing and treatment.



PeerView CME
Published on May 25, 2018
Released April 30, 2018
Ira M. Jacobson, MD, discusses hepatitis C virus in this CME/CE activity titled "HCV From Screening to Cure: A Closer Look at Changing At-Risk Populations and an Evolving Treatment Landscape." For the full presentation and infographics, complete CME/CE information, and to apply for credit, please visit us at http://www.peerview.com/FNC865. CME/CE credit will be available until April 29, 2019.

This CME/CE activity is jointly provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education.

Sunday, April 15, 2018

Michael Kirsch, M.D. - Why I Now Treat Hepatitis C Patients

Michael Kirsch, MD, a full time practicing physician who blogs at “MD Whistleblower ,” in the past has written about the controversies surrounding hepatitis C; from weighing in on the value of HCV screening strategies, treatment risks and benefits, to the price of a cure. After reviewing his previous articles over the years its clear he did not recommend treating HCV patients, today he explains why he has changed his mind, he writes;
Patients come to my office already informed about current HCV treatment. Many are referred to me by physicians expecting me to treat them. The drugs are safe and effective and approved by the F.D.A. Although I still feel we are overtreating, my arguments for holding back have been somewhat dismantled by the new pharmaceutical developments. Am I now at the vanguard of the Medical Industrial Complex?
Check out previous articles, followed by his current take on treating HCV.

2012: 
2018:

April 15, 2018
Why I Now Treat Hepatitis C Patients
Michael Kirsch, M.D.
In a prior post, I shared my heretofore reluctance to prescribe medications to my Hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself – or my patients – to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another specialist who had a different view on the value of HCV treatment.

I do believe that there is a medical industrial complex that is flowing across the country like hot steaming lava. While I have evolved in many ways professionally over the years, I have remained steadfast that less medical care generally results in better outcomes.

Saturday, April 7, 2018

HCV Screening: Important for Rheumatology Patients

HCV Screening: Important for Rheumatology Patients
Cassandra Calabrese, DO, shares her experiences
by Cassandra Calabrese, DO
April 07, 2018
I spent this past week seeing hepatitis C virus (HCV) patients with our hepatologists. Being a rheumatologist, I was looking forward to seeing extrahepatic manifestations of HCV that we read about in textbooks -- cryoglobulinemic vasculitis, sicca syndrome, porphyria cutanea tarda, and many others. I suppose I should not be surprised that the week passed without seeing a single one of these.

While a wide array of extrahepatic manifestations, including may rheumatologic ones, will occur in 40%-70% of chronic HCV patients, the advent of direct-acting antivirals (DAA) has changed HCV outcomes, such that I do not think we will be seeing these cases much longer...

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Other Conditions That May Be Related To HCV

Saturday, March 31, 2018

Strategies for the elimination of HCV infection as a public health threat in the United States

Strategies for the elimination of HCV infection as a public health threat in the United States
Charitha Gowda & Vincent Lo Re III

Full-text shared via Twitter by Henry E. Chang
View PDF
Charitha Gowda
1,2
&
Vincent Lo Re III
2,3,4

Abstract
Purpose of Review Direct-acting antiviral regimens for chronic hepatitis C virus (HCV) infection became available in 2014, and these highly curative therapies have the potential to reduce HCV-associated morbidity and mortality, decrease HCV transmission, and eliminate HCV infection as a public health problem. This review summarizes the recommendations by the National Academies of Sciences, Engineering, and Medicine for a US strategy for HCV elimination.

Recent Findings
To achieve proposed targets of reducing HCV incidence by 90% and decreasing HCV-related mortality by 60% by 2030, there is a critical need to improve HCV diagnosis and linkage to care, reduce HCV-related disease by antiviral treatment scale-up, reduce HCV incidence, and strengthen HCV surveillance to determine achievement of HCV elimination targets over time.

Summary
While HCV elimination is feasible, success of this national effort will require ongoing collaboration and critical resource investment by key stakeholders, including medical and public health communities, legislators, community organizers, and patient advocates



View complete article:
https://jumpshare.com/v/poLU2Wzhg8COI6ACxY5D

Current Hepatology Reports
https://doi.org/10.1007/s11901-018-0394-x

Thursday, March 29, 2018

Hepatitis C in Injection-Drug Users — A Hidden Danger of the Opioid Epidemic

New England Journal of Medicine
Interview with Dr. Jake Liang on the increasing spread of hepatitis C virus associated with injection-drug use.

Perspective
Hepatitis C in Injection-Drug Users — A Hidden Danger of the Opioid Epidemic
T. Jake Liang, M.D.,
and John W. Ward, M.D.
Much has been written about the escalating crisis of opioid-overdose deaths in the United States and its mounting social and economic costs. Although political and public health leaders have begun to confront this urgent problem, hidden beneath it lies another danger: the increasing spread of hepatitis C virus (HCV) associated with injection-opioid use
Related article

Tuesday, March 27, 2018

Hepatitis C Virus Screening Rates Remain Low Among Baby Boomers

Hepatitis C virus screening rates remain low among baby boomers

Nearly half of all cases of US liver cancer are caused by HCV
American Association for Cancer Research

Bottom Line: Despite the steady increase of liver cancer incidence in the United States in recent decades, data from 2015 indicates that less than 13 percent of individuals born between 1945 and 1965 are estimated to have undergone screening for hepatitis C virus (HCV).

Journal in Which the Study was Published: Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Authors: Susan Vadaparampil, PhD, MPH, senior author, senior member and professor, Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida; Monica Kasting, PhD, lead author, postdoctoral fellow, Division of Population Science, Moffitt Cancer Center; Anna Giuliano, PhD, founding director of the Center for Infection Research in Cancer, Moffitt Cancer Center.

Background: "In the United States, approximately one in 30 baby boomers are chronically infected with HCV," said Vadaparampil. "Almost half of all cases of liver cancer in the United States are caused by HCV. Therefore, it is important to identify and treat people who have the virus in order to prevent cancer."

"Hepatitis C is an interesting virus because people who develop a chronic infection remain asymptomatic for decades and don't know they're infected," explained Kasting. "Most of the baby boomers who screen positive for HCV infection were infected over 30 years ago, before the virus was identified."

Because over 75 percent of HCV-positive individuals were born between 1945 and 1965, both the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) now recommend that baby boomers get screened for the virus. However, data from the 2013 National Health Interview Survey (NHIS) indicated that only 12 percent of baby boomers had been screened for HCV, Kasting explained. The researchers wanted to study if HCV screening rates had increased following the FDA approval of several well-tolerated and effective treatments for HCV infection.

How the Study Was Conducted: Using NHIS data from 2013-2015, Kasting and colleagues analyzed HCV screening prevalence among four different age cohorts (born before 1945, born 1945-1965, born 1966-1985, and born after 1985). Participants were asked if they had ever had a blood test for hepatitis C. As the researchers were interested in assessing HCV screening in the general population, they excluded certain populations who were more likely to be screened for the virus, resulting in a total sample size of 85,210 participants.

Results: After multivariable analysis, Kasting and colleagues found that females were screened less often than males in every age cohort. Additionally, among baby boomers and those born between 1966-1985, HCV screening rates were lower among Hispanics and non-Hispanic Blacks. "This is concerning because these groups have higher rates of HCV infection and higher rates of advanced liver disease," noted Kasting. "This may reflect a potential health disparity in access to screening, and therefore treatment, for a highly curable infection."

Among baby boomers, HCV screening rates ranged from 11.9 percent in 2013 to 12.8 percent in 2015. Regardless of the federal screening recommendations, less than 20 percent of baby boomers reported that the reason for their screening was due to their age.

Author's Comments: "Our most important finding is that the HCV screening rate isn't increasing in a meaningful way," said Giuliano. "Between 2013 and 2015, HCV screening only increased by 0.9 percent in the baby boomer population. Given rising rates of liver cancer and high HCV infection rates in this population, this is a critically important finding. It shows that we have substantial room for improvement and we need additional efforts to get this population screened and treated as a strategy to reduce rising rates of liver cancer in the United States."

Study Limitations: Limitations of the study include a reliance on self-reported data. "Another limitation is that this is secondary data and we didn't collect it ourselves," noted Kasting. "There are several questions we would have liked to ask about behavioral risk factors, such as drug use, that weren't utilized on this survey."

Funding & Disclosures: This study was supported by the Biostatistics Core and the H. Lee Moffitt Cancer Center & Research Institute. Kasting is supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH).

As a member of Merck Scientific Advisory Boards, Giuliano and her institution have received funds from Merck. An additional author on the study, David Nelson, MD, has received grant support from Abbvie, Gilead, and Merck. All other authors declare no conflicts of interest.

https://eurekalert.org/pub_releases/2018-03/aafc-hcv032318.php

Sunday, March 18, 2018

Audio Story- Hepatitis C Is More Common In Vietnam Vets, But Nobody Is Sure Why

From: American Homefront Project
PRX » Station » North Country Public Radio
By Sarah Harris • Mar 15, 2018
Produced: Mar 13, 2018
Sarah Harris reports on an effort to get Vietnam vets checked and treated for Hepatitis C.

Article: http://americanhomefront.wunc.org/post/hepatitis-c-more-common-vietnam-vets-nobody-sure-why

The reasons that Vietnam vets are more likely to have hepatitis C are disputed. Kaifetz blames a device called the "jet gun injector" that the military used to vaccinate service members during the Vietnam era. It generated a burst of air pressure to force the vaccine under the skin.

"It was supposed to shoot the injection through your skin cells without piercing the skin with a needle," Kaifetz explained.

Even though the gun wasn't supposed to break the skin, a lot of veterans say it made them bleed. The gun usually wasn't sterilized between each use.

Source:
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting and the Bob Woodruff Foundation.