HCV Special Conference - Worldwide HCV Epidemiology and Impact of Treatment

Website 

AASLD / EASL HCV Special Conference

February 1-2, 2019 

The goal of the conference is to promote global elimination of hepatitis C infection. World leaders in the related disciplines will assemble to establish the current state of the science and public health challenges. The experts will then formulate the most effective future steps toward elimination.

Coverage 

National AIDS Treatment Advocacy Project (NATAP)

Executive Director - Publisher, Editor, Reporter: Jules Levin

View slides and commentary from the HCV special conference over at (NATAP), here are a few presentations to get you started:

Baby Boomers; Is There a Need to Re-Focus our Efforts for Hepatitis C Screening Away from Baby Boomers? 23% HCV+ in Rural Drug Users Pennsylvania

Worldwide; HCV Epidemiology and Impact of Treatment 

What Is The Value Of HCV Treatment?
The Cost of HCV Elimination

Begin here: http://www.natap.org/2019/AASLDEASL/AASLDEASL.htm

Major progress against hepatitis C by 2030 is possible, but will need vast improvements

Lancet Article 
Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model

Alastair Heffernan, MRes Prof Graham S Cooke, DPhil Shevanthi Nayagam, PhD Prof Mark Thursz, MD Prof Timothy B Hallett, PhD

Open Access 
Full-text online
Download PDF
Further improvements in blood safety and infection control, expansion or creation of PWID harm reduction services, and extensive screening for HCV with concomitant treatment for all are necessary to reduce the burden of HCV. These findings should inform the ongoing global action to eliminate the HCV epidemic.

Published: January 28, 2019
DOI:https://doi.org/10.1016/S0140-6736(18)32277-3

Press Release
The Lancet: Major progress against hepatitis C by 2030 is possible, but will need vast improvements in screening, prevention and treatment

First global estimates to determine the impact of improved prevention, diagnosis and treatment, and examine how achievable the WHO elimination targets are.

A comprehensive package of prevention, screening, and treatment interventions could avert 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030 - equal to an 80% reduction in incidence and a 60% reduction in deaths compared with 2015, according to the first study to model hepatitis C interventions globally published in The Lancet.

The estimates suggest that the interventions modelled in the study would reach the elimination targets set by the World Health Organization (WHO) to reduce the number of new hepatitis C infections by 80%, but narrowly miss the target to reduce mortality by 65% - which would instead be reached by 2032.

"Even though it narrowly falls short of the WHO targets for 2030, the impact our estimates suggest would be a tremendous stride forwards," says Professor Alastair Heffernan, Imperial College London, UK, who led the research. "Eliminating hepatitis C virus is an extremely challenging aim that requires improved prevention interventions and screening, particularly in high-burden countries such as China, India, and Pakistan. Across the globe, these options are currently well below the levels we estimate are needed to have a major impact on the epidemic. Research into how to improve this in all settings, as well as increased funding, will be needed if we are to reach these targets." [1]

Globally, it is estimated that 71 million individuals are chronically infected with hepatitis C virus, and 10-20% will develop liver complications including cirrhosis and cancer - which were responsible for over 475,000 deaths in 2015. In recent years, the number of deaths from viral hepatitis infection has risen.

Transmission is most commonly associated with blood transfusions, unsafe healthcare-related injections, and injection drug use. The first two causes of infection have declined globally, but remain an issue in lower income countries. However, infection from injecting drug use is the primary cause in countries where all other causes have been mostly eliminated.

In 2014, direct-acting antivirals were developed, which provide greatly improved cure rates along with reduced side effects and shorter duration of treatment, meaning that more patients can successfully complete treatment than before.

As a result, in 2016, all 194 member states of the WHO have committed to eliminating viral hepatitis as a public health threat. These targets include reducing mortality by 65% and reducing new infections by 80% by 2030, compared with 2015 rates. This is to be achieved by preventing transmission (by improving blood safety and infection control measures, and extending harm reduction services for people who inject drugs), and expanding testing, and increasing treatment with direct-acting antivirals (DAAs) for those already infected.

In the new study, the authors created a model of the global hepatitis C epidemic in 190 countries using data on demography, people who inject drugs, current treatment and prevention programmes, historic trends, prevalence and mortality rates. Using this they estimated the effects of four interventions - implementation of comprehensive blood safety and infection control measures; expansion of harm reduction services (such as opioid substitution therapy and needle and syringe programmes) for people who inject drugs; provision of treatment for all people as soon as they are diagnosed with hepatitis C infection; and expansion of hepatitis C testing, so 90% of people with hepatitis C are diagnosed and offered treatment by 2030.

If things continue as they are, the estimated number of people living with hepatitis C infection will gradually decrease to 58 million in 2050 but could rise by the end of the century. If treatment with direct-acting antivirals is not improved, outcomes could be even worse with considerably higher mortality and new infections.

Implementing comprehensive blood safety and infection control measures was estimated to reduce the number of new infections in 2030 by 58%, compared to if things continue as they are. In addition, extending harm reduction services to 40% of people who inject drugs could reduce the number of new infections by a further 7 percentage points. Together, this would prevent 14.1 million new infections by 2030, but these reductions would not immediately translate into reduced mortality.

To cut future mortality rates more substantially, expanding access to direct-acting antivirals will be essential. Replacing older treatments with direct-acting antivirals in all countries and offering these to all patients at the time of diagnosis could prevent 640,000 deaths from liver cancer and cirrhosis by 2030.

Combining all three interventions and adding screening so that 90% of people with hepatitis C are diagnosed and offered treatment by 2030, would result in the biggest reductions - averting 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030.

The authors note that reducing the global burden of hepatitis C depends on the progress made in just a few countries. Infections and deaths averted, after implementation of the comprehensive package of interventions, are concentrated in a small number of countries, in particular China, India, Pakistan, and Egypt, which are the countries that contribute most to projected new infections by 2030.

"Achieving such reductions requires a massive screening programme and demands a rapid increase in new treatment courses in the short term - namely, 51.8 million courses of direct-acting antivirals by 2030. In the following 20 years, by contrast, the total number required is a much more modest 12 million courses. The reduced treatment requirement after 2030 indicates that rapid testing and treatment scale-up is a means to control the epidemic in the long term, though this must be done within the context of improved hepatitis C prevention measures as well," adds Professor Tim Hallett, Imperial College London, UK. [1]

The authors flag that the efforts to eliminate hepatitis C will entail considerable practical challenges and costs - running into the tens of billions of US dollars by 2030 for a complete viral hepatitis strategy. However, many countries have made substantial progress despite this - with innovative screening strategies being rolled out in Egypt as 700,000 people were treated with direct-acting antivirals in 2016, and Australia negotiating a volume-based pricing model for direct-acting antivirals that encourages, rather than rations, the prescription of expensive treatment courses.

Writing in a linked Comment, Dr Stefan Wiktor, University of Washington, USA, says: "The concept of eliminating hepatitis is gaining traction with the adoption of the WHO strategy, mention of "combatting hepatitis" in the Sustainable Development Goals, and expansion of hepatitis services in some countries. Thus, it is encouraging that the analysis by Heffernan and colleagues shows that this concept is achievable. However, their analysis also indicates that the road to elimination will be difficult. The required expansion of hepatitis services will require political will and substantial new investments from national budgets and global funding sources. The authors do not address the cost of elimination but WHO estimated that implementing its strategy would cost US$11·9 billion for the period 2016-21. Identifying these resources will be particularly difficult at a time of reduced investment in global health and a shift in focus toward universal health coverage rather than disease-specific programmes."

Jan 8 2019
A Commission in The Lancet Gastroenterology & Hepatology studying how to accelerate the elimination of viral hepatitis was also published this month, and is available here: https://www.thelancet.com/commissions/elimination-of-viral-hepatitis

Screen All New Cancer Patients for Hepatitis?

Download Full-Text Article: Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients With Newly Diagnosed Cancer From Academic and Community Oncology Practices

Article download shared by @HenryEChang via twitter... 

Medscape Medical News
January 23, 2019

With no identifiable risk factors in most cases, universal screening before cancer therapy may prevent life-threatening complications.

Screen All New Cancer Patients for Hepatitis?
Kristin Jenkins
A new study has found "a large reservoir of patients with cancer and undiagnosed hepatitis virus infections" and has reignited the question of whether all newly diagnosed cancer patients should be screened for hepatitis.

The Viral Screening in Newly Diagnosed Cancer Patients (S1204) study involved 3051 patients and found that 6.5% had previously been infected with hepatitis B virus (HBV), 0.6% had chronic HBV infection, 2.4% had hepatitis C (HCV) infection, and 1.1% were infected with HIV.

The study was published online on January 17 in JAMA Oncology.

Read more: https://www.medscape.com/viewarticle/908173

Free registration may be required

Opioid and HCV Epidemics - Spreading rapidly in new generations, but boomers bear biggest burden

For Patients: Basic HCV Information

In this program launched by PeerView, Dr. Mark Sulkowski heads an expert panel addressing the evolving opioid and Hepatitis C epidemics. The good doctor will discuss basic HCV information for both the baby boomer generation (born between 1945 and 1965) and a younger at risk population, people less than 40 years old. 

Here are a few highlights to get you started, followed by tips for navigating the presentation.

Did you know?
Hepatitis C is spreading rapidly in new generations, but boomers bear the biggest burden.
Dr. Sulkowski: This group is critically important, because they’ve lived so long with the infection. They’re now presenting with liver disease, such as cirrhosis, decompensation—and they’re what’s behind the rise in liver cancer.. We’ll talk a bit more about that in a minute. And these individuals are dying about 15,000 deaths per year.

Dr. Sulkowski: So, let’s move into the first lecture portion of this, where we’re going to try to cover some of the basics about the burden of hepatitis C, where we stand with treatment and cure, and then we’re going to focus more on the local picture. Hep C is a major cause of mortality in America, more than any other infectious disease, even when you combine them. And I’ll come back to that with some actual data from the CDC. So, [HCV is] a major problem in the United States.

Opiate epidemic in the United States 

18-to 29-year-olds and 30- to 39-year-olds.
Dr. Sulkowski: In parallel with that is hepatitis C. One thing that characterizes this virus is it is very transmissible by blood contamination. But it’s not just reuse of needles; it’s reuse of any of the works, including water, that have been used to prepare drugs.

And it’s so contagious that people acquire it unknowingly. So, you can see that staggering increase in hepatitis C among this population, and that’s what’s driving that second hump on our epidemiology graphics in California but also here in Maryland.

Watch: Addressing the Evolving Opioid and HCV Epidemics Through Community Engagement and Education

Topics

A Closer Look at the Burden of HCV Infection in a New Era of Treatment and Cure

Hepatitis C and Injection Drug Use in the Urban Setting: Perspectives From the Front Lines 

Hepatitis C and Injection Drug Use in the Rural Setting: Perspectives From the Front Lines 

Practice Aids, Slides, Monograph and Live Roundtable Discussion Summary 

Experts discuss working with patients with substance use disorder 

For Patients: How To Navigate The Program 

Begin: Click here

-Select any specialty or profession

-The program will begin

-Interactive questions will appear; respond by clicking "N/A" or click "Next Button" on the top of your screen.

-Pause program click on the video presentation. 

-No registration is required

Recommended Reading

Screening For HCV Is Lacking - Baby Boomers

Screening strategies have been in place for baby boomers since 2012, but according to research, and the American Liver Foundation, "Few boomers are getting screened for hep C'

Screening For HCV Is Lacking - Young People At Risk

Screening young people most at risk for HCV is lacking as well, last month an article written by Michelle Andrews, published by Kaiser Health News (KHN) found facilities ready to serve people who use drugs are not always screening patients, read the article here.

The opioid epidemic is a major contributor to the current rise in HCV infections. Recently, HepVu launched a map on the impact of hepatitis C across the U.S. In some states the map shows a concentration of infections most impacted by the opioid epidemic.

Taking Down the Opioid Crisis 

What you need to know to stay safe and prevent overdose..

Andrew Reynolds writes about the opioid crisis online at POSITIVELY AWARE (PA)

This article will provide you with a broad overview of the scope of the problem, basic information to understand what opioids are and how they lead to overdoses, and some harm reduction tips and resources so that you, or someone you know who uses drugs, can be safe. 

Read it here, follow Andrew on twitter. Visit Project Inform to read additional articles about the opioid crisis. 

Andrew Reynolds
Andrew Reynolds is the Hepatitis C Education Manager at Project Inform, and facilitates several HCV support groups in the San Francisco Bay Area. He's also a counselor on the HELP-4-HEP HCV phoneline (877-435-7443). Call him if you have any questions about HCV care and treatment.

Healio’s Opioid Resource Center

Healio’s Opioid Resource Center compiles the latest stories across a range of specialties, covering the latest research into the epidemic, FDA decisions on treatments and other related announcements.

Thanks for stopping by

Tina 

HCV Next Is Saying Goodbye

I was overcome with great sadness this morning after reading HCV Next, a monthly publication available online at Healio, has published their last issue.

Thank You Healio

Thank you to all those amazing people who made HCV NEXT possible each month. I am so grateful for every outstanding interview, expert analysis, news article and in-depth editorial that was published over the last five years. Please know each issue made a difference in the lives of hepatitis C patients struggling to reach the finish line. 

Your publication will be missed!

Read the November/December Issue. 

Healio HCV News

Please continue to keep up on your HCV news via our other news outlets: Healio Gastroenterology and Liver Disease, Infectious Disease News and, launching soon, Healio Primary Care. 

Hepatitis C -  Barriers To Eradication

Despite all of the advances in hepatitis C treatment, it remains a “silent epidemic” with more than 70 million people infected worldwide. In this months issue of HCV Next, Michael S. Saag, MD., writes about HCV eradication and the huge barriers standing in the way; Passing the Torch from Implementation to Eradication. 

Are You At Risk?
Today, two different groups of people are at risk for hepatitis C; baby boomers, that is people born between 1945 and 1965 and young people - or - people who inject drugs. Although, HCV screening strategies for baby boomers have improved, the same is not true for people who use drugs, as reported by the good people at Imagine Hope recently over at NPR;

"Health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen."

CEO of the American Liver Foundation added;

"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."

Read the article: Why Aren't More Users Of Opioids Or Meth Screened For Hepatitis C?

NEW @ JAMA

During 2013 to 2016, what proportion of adults were living with hepatitis C virus (HCV) infection in each US state?

December 21, 2018
Regions with long-standing HCV epidemics, and those with newly emergent ones partly driven by the opioid crisis, face substantial HCV prevalence.

Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016

Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure. The urgency for action and the resources necessary will vary by jurisdiction.

In The News
Dec 21, 2018
JAMA In The News: Hepatitis C Cases Cluster in States Hit Hard by Opioids

FRIDAY, Dec. 21, 2018 (HealthDay News) -- More than half of Americans with hepatitis C are living in just nine U.S. states -- five of those in a region hit hard by the opioid epidemic, a new study shows.

Dec 19, 2018
Medscape: Hep C and Drug Abuse Often Go Hand in Hand, but Screening Lags
Recent studies have shown that health care facilities often fail to screen people who use drugs. Not testing these patients for hepatitis C is an enormous missed opportunity, public health experts agree.

Young People with Hepatitis C Face Cirrhosis at Younger Age 

Dec 16, 2018
One-third (32%) of people who contract hepatitis C virus (HCV) as a child will go on to develop cirrhosis at a median of 33 years post-infection, according to new research.

Until next time.

Tina

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.

Read more:
https://www.reuters.com/article/us-health-egypt-hepatitis-c/millions-flock-to-free-tests-as-egypt-seeks-to-eradicate-hepatitis-c-idUSKBN1O21IO

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:

https://www.youareunltd.com/2018/11/29/hepatitis-c-screening-and-new-treatment-options-allow-baby-boomers-to-escape-the-kiss-of-death/

HCV epidemic continues to rise among young adults

Of Interest 
AASLD 2018 The Liver Meeting®:

People with Hepatitis C Who Actively Inject Illegal Drugs Have High Rates of Hepatitis C Treatment Adherence and Cure 

“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."

Read More: https://www.empr.com/news/hepatitis-c-virus-screening-diagnosis-rates-united-states-rna-testing-antibody/article/815299/

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

Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016

View Slides: National Estimates for HCV Screening and Diagnosis Rates in the United States (2013-2016) Based on a Large Real-World Dataset

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

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

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:

https://hepatitiscnewdrugs.blogspot.com/2018/11/over-2-million-americans-have-hepatitis.html

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/

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.

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.

http://healthnews.uc.edu/news/?/30274/

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:

 https://www.medpagetoday.com/gastroenterology/hepatitis/75118

Primary Source

Clinical Gastroenterology and Hepatology

Source Reference: Eckman MH, et al “Cost effectiveness of universal screening for HCV infection in the era of direct-acting, pangenotypic treatment regimens” Clin Gastroenterol Hepatol 2018. DOI: 10.1016/j.cgh.2018.08.080.

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

Full Text

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.

Continue reading: https://jumpshare.com/v/UEhb4EjH69Q2CSRadDTL

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

https://eurekalert.org/pub_releases/2018-07/a-cus062818.php

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

https://www.britishlivertrust.org.uk/7-in-10-people-with-liver-disease-dont-know-they-have-it/

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).

Link: https://soundcloud.com/cmajpodcasts/170453-guide

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. 1–3 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.1–3 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,13–15 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