Wednesday, December 20, 2017

Hepatitis C is now curable, but what happens with cirrhosis and portal hypertension afterwards?

Clinical and Experimental Hepatology
Review paper
Hepatitis C is now curable, but what happens with cirrhosis and portal hypertension afterwards?
Ivica Grgurevic, Tonci Bozin, Anita Madir
Clin Exp HEPATOL 2017; 3, 4: 181-186

The appearance of direct-acting antivirals (DAA) in 2011 marked the beginning of a new era in hepatitis C treatment. Since 2014, ‘all-oral therapy’ has been introduced, with nearly a 100% successful eradication rate for the hepatitis C virus (HCV) achieved, including cirrhotic patients [1]. It has been well documented that viral clearance upon receiving therapy generally results in reduced morbidity and mortality from chronic liver disease [2], but how this influences clinical outcomes in patients with already established cirrhosis and portal hypertension (PH), as the most endangered cohort, is a matter of debate. In other words, does the HCV cure translate into halting the progression of liver disease, and does it lead to the reversal of cirrhosis into lower histological stages and regression of PH? The theoretical background that allows for these issues to be addressed has only recently been established, characterized by the modern concept that views cirrhosis and PH as dynamic processes in the context of advanced chronic liver disease [3].

Monday, December 18, 2017

China: MSF challenges Gilead’s patent application for hepatitis C treatment

In case you missed it

China: MSF challenges Gilead’s patent application for hepatitis C treatment

Médecins Sans Frontières (MSF) has filed a legal patent challenge in China against US pharmaceutical corporation Gilead’s patent application for the combination of two crucial oral hepatitis C medicines, sofosbuvir and velpatasvir. This combination is the first direct-acting antiviral (DAA) treatment to be registered for use against all genotypes of the disease. Rejection of patents for this combination would pave the way towards the availability of affordable generic versions of this treatment that millions of people need in China and around the world....

Friday, December 15, 2017

Formulary exclusion lists make it harder for patients to get prescriptions

Formulary exclusion lists make it harder for patients to get prescriptions
By Ginger Christ, The Plain Dealer

CLEVELAND, Ohio - Getting a prescription these days requires more than just a visit to your doctor.

Insurance companies use formulary exclusion lists to dictate which prescriptions are covered, and the number of medications on those lists continues to grow as prescription insurers try to cut costs.

The excluded medications are often times ones that aren't prescribed very often or that have generic alternatives, but recently a couple of specialty drugs, including some for Hepatitis C, are also popping up on these lists...

Community Health Clinics Evolving HCV Programs

AGA Reading Room 12.14.2017

Community Health Clinics Evolving HCV Programs
by Pippa Wysong
Increasing importance in treating high-risk populations
Community health clinics (CHCs) are taking on greater roles in terms of screening and treating hepatitis C virus (HCV) patients, but new models of care are just starting to evolve to improve access and care for the high-risk, complex populations they tend to serve...

Expert Critique
Michelle Long
With the wide availability of highly effective treatments for hepatitis C (HCV) the challenges in treating HCV now lies in improving access for high-risk populations. Federally funded community health clinics are now a prime access point for screening and treating HCV, particularly for the uninsured or under-insured. HCV is highly prevalent in the patient population served by community health clinics, which make them a good place to identify high-risk patients. However, the infrastructure for coordinating screening and delivering treatments needs development in many community health clinics. Additional training programs for primary care physicians and telemedicine programs would be helpful as well, since access to sub-specialty care is often limited. Few centers have adapted existing programs with success, but this has not yet been adapted on a large scale, and funding for such efforts is limited.

8-week Harvoni cost-effective alternative to 12-week regimen

December 14, 2017
An 8-week course of Harvoni for hepatitis C virus infection in both black and nonblack patients was a cost-effective alternative to a 12-week course, according to researchers.

Shorter course therapy may be a viable option under a constrained budget and can benefit patients who are treatment-naive and noncirrhotic, they wrote in Open Forum Infectious Diseases.
Continue reading:

SVR after HCV treatment improves liver stiffness in progressive fibrosis
December 14, 2017
Sustained virologic response after direct-acting antiviral treatment for hepatitis C significantly improved liver stiffness from baseline to end of treatment, and…
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Wednesday, December 13, 2017

HCV Prevention in Correctional Settings Is Good Medicine

Clinical Thought
HCV Prevention in Correctional Settings Is Good Medicine
Lara Strick MD, MS - 12/12/2017

Implementation of prevention services targeting incarcerated patients is possible. Let me tell you why. 
Although the United States lags far behind in public acceptance and implementation of harm reduction services like condoms, needle exchanges, and regulated tattooing in the correctional setting, it is important to note that other countries have successfully launched such programming. For now, we need to rely on risk reduction counseling to augment prevention ahead of full maturation of our harm reduction initiatives. For instance, medication assistance for drug addiction is steadily garnering more attention across the United States as the public profile of the opioid epidemic expands, increasing the political will to broaden efforts to correctional facilities. 
But perhaps the most important thing to remember is this: Implementation of prevention services targeting incarcerated patients is possible. Do not let the fact that you are serving a correctional population prevent you from practicing good medicine because, ultimately, prevention is good medicine.
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Related Discussions - Clinical Care Options

Dr. Gabor Maté on the Trauma Underlying the Stigma of Addiction: An Interview

Dr. Gabor Maté on the Trauma Underlying the Stigma of Addiction: An Interview
By John Lavitt 12/12/17

There are legitimate uses of opioids in the treatment of physical pain. There is no legitimate use in the treatment of emotional pain.

When commenting on the neurobiology of addiction, you write how, “addiction is related psychologically, in terms of both emotional pain relief and neurobiological development, to early adversity.”

If the neurobiological development of a child is affected by trauma, how can such physical changes set in place long ago be reversed? Is it possible for an adult to “renew” their brain, and if so, how long would such a process of renewal take? What tools would be required?

When we do brain scans on adult addicts, you see several neural systems that just don’t work very well, including the opiate pain relief, pleasure, reward, attachment, and love circuitry. Other problematic systems include the stress regulation circuitry, the impulse regulation circuitry, and especially the dopamine-driven incentive motivation circuitry. As a result, doctors often conclude that because these brain circuits aren’t working well, there has to be a brain disease and that addiction is that disease.....

View Part 1 of a 2 part interview

Video HCV Series from Medscape TV - Patient education and screening

Six Episode Series from Medscape TV - Hepatitis C Virus: Containing the Threat
In the past few years, a new class of direct-acting antiviral agents has made the treatment of HCV easier and more effective than ever before, with cure rates nearing 100%, even among HIV-positive patients. But not all patients with HCV who are eligible for antiviral treatment are identified, and even fewer are being referred for care. Thus, HCV infection remains a significant risk for progression to cirrhosis, liver failure, and hepatocellular carcinoma. Liver specialists at two prestigious Chicago medical centers confront the key issues in the management of patients with chronic HCV infection.

Medscape TV Final Episode
December 11, 2017
EPISODE 6 - Strategies for Prevention
Primary care physicians can help stem the spread of HCV infection through patient education and screening

November 8, 2017 
EPISODE 5 - Hepatitis C Virus: Dealing With Chronic Disease
Patients with advanced disease will need help beyond current therapy, including managing comorbidities and navigating transplant.

October 10, 2017

EPISODE 4 - The New Regimens
Liver specialists find that HCV patients who have comorbid conditions and treatment-resistant disease may still be candidates for combination therapies.

August 17, 2017
EPISODE 3 - Hope and Uncertainty
Patients who have not responded to previous HCV therapies often need support to continue therapy and testing, and to maintain health.

July 17, 2017
EPISODE 2 - Considerations Before HCV Therapy
Physicians assess such factors as performance status and risk for reinfection to determine whether a patient is a candidate to receive HCV treatments.

June 21, 2017
EPISODE 1 - Strides and Obstacles
HCV treatments are highly efficacious, but challenges remain in screening persons at risk of contracting and spreading infection, as well as in the treatment of liver diseases caused by HCV