SVR 24 Two Weeks After a Tripled Dose of Daclatasvir in an HCV Genotype 3 Patient (Case Report)

Case Report

Ann Hepatol. 2018 July - August ,;17(4):661-664. doi: 10.5604/01.3001.0012.0950.

SVR 24 Achievement Two Weeks After a Tripled Dose of Daclatasvir in an HCV Genotype 3 Patient.
Lo Menzo S1, Biagi E1, Di Nuzzo M1, Grilli A1, Contini C1.

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Abstract

Directly-acting antivirals (DAA) have changed the chronic hepatitis C virus (HCV) infection therapeutic scenario allowing virus eradication in more than 95% of patients, independently from the genotype, with 12 to 24-week treatment regimens. We describe a 51-year-old Pakistani man with a chronic HCV-genotype 3 (GT3a) infection with moderate liver fibrosis, who achieved sustained virological response (SVR) 24 after a tripled dose of Daclatasvir (DCV) taken erroneously associated to Sofosbuvir (SOF). The patient had a concomitant intestinal TB infection whose treatment had been delayed in order to firstly eradicate HCV to reduce the liver toxicity of anti-mycobacterial drugs. Thanks to the cultural mediator support, we explained to the patient the correct posology of each drug to take during the day consisting of 12 week SOF (400 mg daily) plus DCV (60 mg daily) regimen. He returned 13 days after for a programmed visit and we were surprised to learn that he had taken 3 pills of DCV (180 mg/daily) instead of one, thus ending DCV assumption after only 9 days while SOF was taken correctly. He complained no symptoms. We immediately performed blood test that showed alteration of lactate dehydrogenase, creatine phosphokinase, and creatin kinase MB activity. At day 15 we stopped SOF closely monitoring the patient. Blood test alterations returned normal after one week of treatment suspension, HCV viremia remained suppressed after 4, 12 and 24 weeks proving HCV eradication. If confirmed, these data could suggest that higher doses of DCV, if tolerated, might be employed in short-time HCV-GT3 treatment.

PMID: 29893709 DOI: 10.5604/01.3001.0012.0950 

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 http://annalsofhepatology.com/revista/numeros/2018/HP184-18-SRV24%20(F_120618m)_PROTEGIDO.pdf

Diagnosis and Treatment of HCC Varies by Race

MedPage Today

Diagnosis and Treatment of HCC Varies by Race

Blacks and Hispanics less likely to get surveillance, early diagnosis, and curative treatment
by Diana Swift, Contributing Writer June 14, 2018

A large retrospective study of hepatocellular (HCC) patients in Texas found racial and ethnic differences in outcomes, with blacks and Hispanics less likely than whites to get early diagnosis and curative treatment, and blacks less likely to survive.

"Our findings have important implications for health policy and highlight the need for further study on racial-ethnic disparities in HCC, including identification of additional actionable intervention," wrote Amit Singal, MD, MS, of the University of Texas (UT) Southwestern Medical Center's Simmons Cancer in Dallas, and colleagues in Clinical Gastroenterology and Hepatology
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https://www.medpagetoday.com/gastroenterology/generalhepatology/73501

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Canadian team reports success in transplanting hepatitis C organs

Toronto doctors safely transplant lungs from hepatitis C-infected donors
by Sheryl Ubelacker, The Canadian Press

Last Updated Jun 14, 2018 at 8:24 am EDT

Toronto doctors have successfully transplanted lungs from deceased donors with hepatitis C into patients in need of the lifesaving organs, followed by treatment to prevent them from becoming infected with the potentially liver-destroying virus.

Since October, surgeons at Toronto General Hospital have performed the transplants in 11 patients as part of a pilot study to evaluate the safety of using lungs from hepatitis C-infected donors — a previously untenable idea.

That’s because antiviral drugs can now cure the disease in 98 per cent of people infected with hepatitis C, which affects an estimated 250,000 Canadians, about 40 to 70 per cent of them unaware they harbour the blood-borne virus.

“With the opioid crisis and persistent high rates of intravenous drug use, we have a great number of potential lung donors who are hepatitis C-positive, many of whom didn’t even know they were sick when they were alive,” said Dr. Marcelo Cypel, a thoracic surgeon at TGH and principal investigator of the study.

Continue reading: https://toronto.citynews.ca/2018/06/14/hepatitis-c-lung-transplant/

Canadian team reports success in transplanting hepatitis C organs

WASHINGTON: A long-running shortage in donor organs has pushed doctors to find ways to use those with hepatitis C, an infection that is increasingly common in the United States due to the opioid crisis, and which can be cured with medicine.

Some US hospitals, particularly in Boston, have already transplanted infected donor organs into people without hepatitis C. These patients are swiftly treated with drugs to eliminate the virus.

In Toronto, Canada, another team of doctors on Thursday announced early results from a trial using a different technique, involving 10 people who received lung transplants from donors with hepatitis C.

Continue reading: 

https://www.nst.com.my/world/2018/06/380180/canadian-team-reports-success-transplanting-hepatitis-c-organs

Scotland’s reduction in new HCV infections due to harm reduction, not treatment

Keith Alcorn 

Published: 12 June 2018

The reduction in new hepatitis C virus (HCV) infections that has taken place in Scotland since 2008 is most likely due to increased provision of needle and syringe programmes and opioid substitution therapy, rather than a reduction in the number of people with hepatitis C as a result of increased treatment of HCV infection, a modelling study published in the journal Addiction reports.

Read the article here: http://www.infohep.org/Scotlands-reduction-in-new-HCV-infections-due-to-harm-reduction-not-treatment/page/3288867/

Hepatitis C Care in the Department of Veterans Affairs: Building a Foundation for Success.

Infect Dis Clin North Am. 2018 Jun;32(2):281-292. doi: 10.1016/j.idc.2018.02.011.
Hepatitis C Care in the Department of Veterans Affairs: Building a Foundation for Success.
Belperio PS1, Chartier M2, Gonzalez RI3, Park AM4, Ross DB2, Morgan TR5, Backus LI6.

PMID: 29778256 DOI: 10.1016/j.idc.2018.02.011 

Article shared by Henry E. Chang via Twitter

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KEYWORDS  
Veterans Direct-acting antiviral SVR Hepatitis C Population health Innovation System redesign

KEY POINTS
Since January 2014 the Department of Veterans Affairs (VA) has made significant progress in the treatment of veterans with hepatitis C virus (HCV) and, as of December 2017, more than 100,000 veterans have been treated.

Special regional multidisciplinary Hepatitis C Innovation Teams were created that used lean process improvement and system redesign, resulting in innovative hepatitis C practice models that help to address gaps in care.

The VA has expanded access and treatment capacity for HCV-infected veterans through the use of nonphysician providers (clinical pharmacists, nurse practitioners, and physician assistants), video telehealth, and electronic technologies.

The VA continues to use population health management tools to effectively manage and track the treatment and care of veterans with HCV.

Abstract

The Department of Veterans Affairs (VA) has made significant progress in treating hepatitis C virus, experiencing more than a 75% reduction in veterans remaining to be treated since the availability of oral direct-acting antivirals. Hepatitis C Innovation Teams use lean process improvement and system redesign, resulting in practice models that address gaps in care. The key to success is creative improvements in veteran access to providers, including expanded use of nonphysician providers, video telehealth, and electronic technologies. Population health management tools monitor and identify trends in care, helping the VA tailor care and address barriers.

Continue reading: https://jumpshare.com/v/mthQnTLKcsJETo8vlxug

High SVR12 with 8-week and 12-week glecaprevir/pibrentasvir therapy: An integrated analysis of HCV genotype 1–6 patients without cirrhosis

High SVR12 with 8-week and 12-week glecaprevir/pibrentasvir therapy: An integrated analysis of HCV genotype 1–6 patients without cirrhosis

DOI: https://doi.org/10.1016/j.jhep.2018.03.007

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Highlights

•A short-duration, pangenotypic cure for HCV infection may help treat more patients.

•Glecaprevir plus pibrentasvir (G/P) therapy for 8 weeks had an overall cure rate of 98%.

•The efficacy of 12-week G/P therapy (99%) was not significantly higher than that of 8-week G/P therapy (p = 0.2).
•Treatment responses were high irrespective of any baseline patient or viral trait.

•G/P demonstrated a favourable safety profile regardless of treatment duration.

Background & Aims
Glecaprevir plus pibrentasvir (G/P) is a pangenotypic, once-daily, ribavirin-free direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) infection. In nine phase II or III clinical trials, G/P therapy achieved rates of sustained virologic response 12 weeks after treatment (SVR12) of 93–100% across all six major HCV genotypes (GTs). An integrated efficacy analysis of 8- and 12-week G/P therapy in patients without cirrhosis with HCV GT 1–6 infection was performed.

Methods
Data were pooled from nine phase II and III trials including patients with chronic HCV GT 1–6 infection without cirrhosis who received G/P (300 mg/120 mg) for either 8 or 12 weeks. Patients were treatment naïve or treatment experienced with peginterferon, ribavirin, and/or sofosbuvir; all patients infected with HCV GT 3 were treatment naïve. Efficacy was evaluated as the SVR12 rate.

Results
The analysis included 2,041 patients without cirrhosis. In the intent-to-treat population, 943/965 patients (98%) achieved SVR12 when treated for eight weeks, and 1,060/1,076 patients (99%) achieved SVR12 when treated for 12 weeks; the difference in rates was not significant (p = 0.2). A subgroup analysis demonstrated SVR12 rates > 95% across baseline factors traditionally associated with lower efficacy. G/P was well tolerated, with one DAA-related serious adverse event (<0.1%); grade 3 laboratory abnormalities were rare.

Conclusions
G/P therapy for eight weeks in patients with chronic HCV GT 1–6 infection without cirrhosis achieved an overall SVR12 rate of 98% irrespective of baseline patient or viral characteristics; four additional weeks of treatment did not significantly increase the SVR12 rate, demonstrating that the optimal treatment duration in this population is eight weeks.

Lay summary

In this integrated analysis of nine clinical trials, patients with chronic HCV genotype 1–6 infection without cirrhosis were treated for either 8 or 12 weeks with the direct-acting antiviral regimen glecaprevir/pibrentasvir (G/P). The cure rate was 98% and 99% following 8 and 12 weeks of treatment, respectively; the difference in rates was not significant (p = 0.2), nor was there a significant difference in the cure rates across the two treatment durations on the basis of baseline patient or viral characteristics. These results, along with a favourable safety profile, indicate that G/P is a highly efficacious and well-tolerated pangenotypic eight-week therapy for most patients with chronic HCV infection.

View Article Online: https://www.journal-of-hepatology.eu/article/S0168-8278(18)30165-X/fulltext

Modeling NAFLD Disease Burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030

Modeling NAFLD Disease Burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030

https://doi.org/10.1016/j.jhep.2018.05.036

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Highlights

•Fatty liver disease is a growing cause of cirrhosis and liver cancer globally.

•Disease burden is expected to increase with the epidemics of obesity and diabetes.

•Modeling shows slow growth in total cases and greater increase in advanced cases.

•Mortality and advanced liver disease will more than double during 2016-2030.

Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) with resulting nonalcoholic steatohepatitis (NASH) are increasingly a cause of cirrhosis and hepatocellular carcinoma (HCC) globally. This burden is expected to increase as epidemics of obesity, diabetes and metabolic syndrome continue to grow. The goal of this analysis was to use a Markov model to forecast NAFLD disease burden using currently available data.

Methods
A model was used to estimate NAFLD and NASH disease progression in 8 countries based on data for adult prevalence of obesity and type 2 diabetes mellitus (DM). Published estimates and expert consensus were used to build and validate the model projections.

Results
If obesity and DM level off in the future, we project a modest growth in total NAFLD cases (0-30%), between 2016-2030, with the highest growth in China as result of urbanization and the lowest growth in Japan as result of a shrinking population. However, at the same time, NASH prevalence will increase 15-56%, while liver mortality and advanced liver disease will more than double as result of an aging/increasing population.

Conclusions
NAFLD and NASH represent a large and growing public health problem and efforts to understand this epidemic and to mitigate the disease burden are needed. If obesity and DM continue to increase at current and historical rates, both NAFLD and NASH prevalence are expected to increase. Since both are reversible, public health campaigns to increase awareness and diagnosis, and to promote diet and exercise can help manage the growth in future disease burden.

Lay summary
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) can lead to advanced liver disease, and are occurring in increasing numbers in tandem with epidemics of obesity and diabetes. A mathematical model was built to understand how the disease burden associated with NAFLD and NASH will change over time. Results suggest increasing numbers of cases of advanced liver disease and liver-related mortality in the coming years.

Continue to article: View Online

Blogger Updates: Opioid & hepatitis C epidemic

Thanks for stopping by, we begin with an article about the opioid & hepatitis C epidemic, published today online over at Harvard Law;

Hepatitis C Virus Infection: Another Consequence of the Opioid Epidemic
HCV is matching the grim statistics of marching hand-in-hand with the opioid epidemic and we must make sure treatment is available to everyone.

In The News

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Sofosbuvir-velpatasvir-voxilaprevir effective in previously treated chronic hepatitis C

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See you soon,

Tina

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