This blog is all about current FDA approved drugs to treat the hepatitis C virus (HCV) with a focus on treating HCV according to genotype, using information extracted from peer-reviewed journals, liver meetings/conferences, and interactive learning activities.
Risk Of Developing Liver Cancer After HCV Treatment
A study in mice revealed a connection between bacteria in the gut and antitumor immune responses in the liver.
The findings have implications for understanding the mechanisms that lead to liver cancer and developing approaches to treat it.
The microbiome is the community of bacteria and other microbes that live in or on the body. The greatest proportion of the human microbiome is in the intestine, or gut. Recent research has found that the gut microbiome can influence many conditions, including cancer growth.
Cancer is commonly found in the liver. Most of the time, it’s from a cancer that started somewhere else in the body, broke off, and spread to the liver. About 75% of the blood that reaches the liver travels through the portal vein from the digestive tract. That blood includes substances from the gut microbiome. To understand how certain gut bacteria may influence the development of tumors in the liver, a team led by Dr. Tim Greten at NIH’s National Cancer Institute (NCI) carried out a series of experiments in mice. Their study was published on May 25, 2018, in Science.
The scientists tested mouse models of liver cancer. They first depleted certain bacteria from the animals’ guts using antibiotics. Mice given the antibiotics developed fewer and smaller liver tumors.
To understand how the depletion of gut bacteria suppressed tumor growth, the investigators examined immune cells in the liver. They found that antibiotic treatment increased the numbers of natural killer T (NKT) cells, a type of immune cell. Further experiments showed that, in all the mouse models tested, the reduction in liver tumor growth from the antibiotic treatment was dependent on NKT cells.
NKT cells interact with a protein on cell surfaces called CXCL16. The team examined CXCL16 in the cells that line the inside of capillaries in the liver. They found that the accumulation of NKT cells in the liver resulted from an increase in CXCL16.
The scientists next searched for the link between gut microbes and CXCL16. Gut microbes are known to modify bile acids, which are made by the liver to help break down fats during digestion. Through a series of experiments, the team showed that altered bile acids from the gut reduced CXCL16 levels when they traveled back into the liver. Confirming this idea, the team fed different types of bile acids to the mice and found that they affected tumor growth differently in the liver.
The researchers identified a type of bacterium in the gut, Clostridium, that modifies bile acids. Antibiotics that kill Clostridium allow bile acids from the gut to increase levels of CXCL16 and NKT cells in the liver, which inhibits liver tumor growth.
“What we found using different tumor models is that if you treat mice with antibiotics and thereby deplete certain bacteria, you can change the composition of immune cells of the liver, affecting tumor growth in the liver,” Greten says. “This is a great example of how what we learn from basic research can give us insight into cancer and possible treatments.”
These findings in mice may also apply to people with liver cancer. In preliminary work, the researchers showed that different bile acids can also control CXCL16 levels in human liver samples. Further work will be needed to understand the significance of these mechanisms in people.
In Case You Missed It *Article downloaded and shared by @HenryEChang via Twitter. Cost‐effectiveness of generic pan‐genotypic sofosbuvir/velpatasvir versus genotype‐dependent direct‐acting antivirals for hepatitis C treatment
Amit Goel Qiushi Chen Jagpreet Chhatwal Rakesh Aggarwal
First published: 04 June 2018 https://doi.org/10.1111/jgh.14301 Download Full-Text PDF Download
Abstract
Background
Treatment of HCV infection with low‐cost generic direct‐acting antivirals (DAAs) available in India and other developing countries needs determination of HCV genotype (‘genotype‐dependent' regimens). Generic velpatasvir, a DAA that obviates the need for genotype determination (‘pan‐genotypic' regimen) recently became available but is costlier.
Aim
To evaluate the cost‐effectiveness of genotype‐dependent versus pan‐genotypic DAA treatments in India.
Methods
A previously‐validated microsimulation model, adapted to Indian population, was used to compare the costs and long‐term outcomes of three scenarios: no treatment, and treatment with genotype‐dependent and pan‐genotypic regimens. Input parameters were derived from literature. Using a payer's perspective and life‐time time horizon, quality‐adjusted life years (QALYs), total costs, and incremental cost‐effectiveness ratio (ICER) were calculated. Both deterministic and probabilistic sensitivity analyses were also conducted.
Results
At the current price (US$ 223 for 4 weeks), pan‐genotypic regimen was cost‐saving compared to no treatment. Compared with genotype‐dependent regimens, it increased QALYs by 0.92 and increased costs by US$ 107, but was deemed cost‐effective with an ICER of US$ 242 per QALY gained. Probabilistic sensitivity analysis also supported the cost‐effectiveness of pan‐genotypic regimen. At the reduced price of US$ 188 for 4 weeks, the pan‐genotypic regimen will become cost‐neutral to genotype‐dependent regimens (current price: US$100 for 4 weeks).
Conclusions
At current prices, velpatasvir‐based pan‐genotypic regimen is cost‐effective for HCV treatment in India where generic drugs are available. A reduction in the prices of pan‐genotypic regimen has the potential to make its use cost‐saving, while simplifying treatment in community‐level programs aimed at HCV elimination.
Continue reading: https://jumpshare.com/v/AGnldst6EL08X8iGM13N
Available On This Blog The controversy over expensive new drugs for hepatitis C
Link to research and news articles addressing the high cost of hepatitis C drugs; insurance restrictions - private insurers/Medicaid - and availability of generic versions/India, Egypt and other lower-income countries or through online "buyers clubs"
https://doi.org/10.1111/ajt.14960
In this issue of the journal, Drs. Axelrod et al. aimed to investigate the impact of
direct-acting antiviral agents for Hepatitis C (HCV) on liver and kidney transplant
outcomes and cost for HCV positive patients. Link Download PDF Article
Given that hepatitis C therapy is recommended for all patients who do not have a
short life expectancy, certainly all transplant recipients should be treated for hepatitis C
in the early post-transplant period prior to developing any significant liver disease in the
liver allograft or progressive disease in the renal transplant recipient. Early therapy would
also prevent any cases of cholestatic hepatitis. Given that hepatitis C therapy is likely
cost-effective in the non-transplant setting, it would certainly be cost-effective in the
transplant setting. One would hope that we are doing better with pangenotypic lower
cost DAA options with fewer drug-drug interactions now available. Given the WHO's
recommendation for HCV elimination by 2030, the fact that the transplant community has
not been able to eliminate HCV in our transplant recipients remains a concern. Better
education of our providers, advocacy for our patients, and better access to medications
are the only solution to this problem. I certainly hope we get there soon.
David E. Bernstein, MD, FAASLD, discusses the possibility of an HCV cure rate of 100% Is an HCV cure rate of 100 percent realistic?
David E. Bernstein, MD, FAASLD, wants to break down the barriers preventing access to curative therapies for hepatitis C virus (HCV). Although antiviral therapy has led to a cure rate of more than 90 percent of HCV cases, Dr. Bernstein thinks more can be done to increase the cure rate.
In this DDW Daily News video exclusive, he discusses several obstacles preventing patients’ access to curative therapies, including cost concerns, public policy issues and insurance variations that have led to different state rules and regulations. Dr. Bernstein also addresses the benefits of HCV therapy and whether it’s possible to eradicate HCV and achieve 100 percent cure rate.
“It’s the only viral disease that we can actually cure, but from a public policy standpoint a significant portion of our population does not have access to these life-changing and curative therapies for unclear reasons,” says Dr. Bernstein, director of the Sandra Atlas Bass Center for Liver Diseases at the Zucker School of Medicine at Hofstra/Northwell, East Garden City, NY.
WASHINGTON -- Adults with hepatitis C virus (HCV) were more likely to die if they were on Medicaid than other insurance plans, while uninsured HCV-infected …
Digestive Disease Week® (DDW) 2018
Coverage @ Healio
Healio staff will report live on breaking news presented at the meeting and capture video interviews with experts to gain their perspectives on important presentations.
Welcome, we start with a few June publications, followed by events you may have missed last month. Next, sift through the June index of newsletters, and finish off with a list of well written blogs with extremely useful information on the topic of viral hepatitis. June Updates A Guide to Understanding Hepatitis C (HCV)
HCV Advocate: We have completely updated and given our most popular publication and a new look. To download, click here
Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.
Updated Guidelines - 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.
What You Missed In May Screening for Hepatitis C Climbs in Colorado Each year, more Coloradans are contracting hepatitis C, the infectious liver disease spread by contact with infected blood. The state’s hep C death rate is heading higher as well. An analysis by the Colorado Health Institute of newly available information from the state’s All Payer Claims Database (APCD) reveals the rate of Coloradans getting screened for the hepatitis C virus nearly tripled between 2011 and 2016.
Key Takeaways:
The rate of screening for hepatitis C among Coloradans nearly tripled between 2011 and 2016, a Colorado Health Institute analysis of newly available data shows.
Baby boomers between ages 55 and 64 saw the largest increase in screening rates during that time; millennials between 25 and 34, had the highest screening rate each year.
Medical advances, federal and state policy changes and fallout from the opioid epidemic have contributed to the rise in screening.
Full of Life: The Stories of People Affected by Hepatitis C
The Institute’s Hepatitis Policy Project has released a new report that features the stories of people affected by hepatitis C. The report was authored by Sonia Canzater and Jeffrey S. Crowley. “Full of Life: The Stories of People Affected by Hepatitis C,” underscores the impact of hepatitis C and the potential for improving the lives of those with the disease.
Real people make up the HCV epidemic, and their experiences and the full lives they lead offer motivation and resolve to work to eliminate HCV as a public health threat. But, as this report will show, the reality of what is happening to respond to HCV in the United States (US) falls short of the possibility of what we could make happen to save lives and strengthen communities, read it here....
This project is supported by a grant from Gilead Sciences. AASLD online HCV guide update includes key at-risk populations
May 31, 2018
The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recently updated their hepatitis guideline website, HCVguidelines.org, to include several new testing and management recommendations for pregnant women, men who have sex with men, people who inject drugs and incarcerated individuals. Kristen M. Marks, MD, assistant professor of medicine at Weill Cornell Medical College in New York and HCV Guidance co-chair, discussed the new updates with HCV Next, read it here...
New Hepatitis C Virus Guidelines and Lyme Disease Prevention
The FDA and the Next Wave of Drug Abuse — Proactive Pharmacovigilance
In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks, read the article here...…
Surrey develops hepatitis C model that could help improve treatment
The University of Surrey has created a new mathematical model that details how the hepatitis C (HCV) infection develops and behaves more accurately than previous models, read the press release, here..... New strategy to cure chronic hepatitis B infection
Scientists from Karolinska Institutet and Hannover Medical School have published two studies that provide insights into how the immune system responds and helps to clear a hepatitis B infection after treatment interruption. The findings offer a framework for future tailored treatment strategies and are published in The Journal of Infectious Diseases and Journal of Hepatology, read it here....
Conditions Related To HCV
Listen - Hepatitis C: It’s About More than Liver Disease
The National Viral Hepatitis Roundtable is pleased to present a webinar to discuss the health effects of hepatitis C virus (HCV) infection that occur outside the liver. Learn more about how conditions such as kidney disease, depression, certain types of cancer, and diabetes are related to HCV infection. The webinar will feature clinician and patient perspectives to facilitate discussion about the importance of recognizing these conditions as part of HCV management and the implications for early HCV treatment.
This webinar is now archived. Click here for the slides. Click here for the recording. (Click the link and then enter the requested information to view the webinar). Fatigue & Achieving SVR
Do fatigue and quality of life improve after hepatitis C is cured?
Patient-reported outcomes such as fatigue, vitality and mental health improve substantially in the two years following hepatitis C cure for people with cirrhosis, but people with cirrhosis are less likely than others to experience rapid resolution of severe fatigue after successful hepatitis C treatment, according to two studies from the Center for Outcomes Research in Liver Diseases reported last month at the 2018 International Liver Congress in Paris, read it here...
Fibrosis
Can anti-viral therapy reduce liver fibrosis and steatosis in patients with chronic hepatitis C virus?
In this study, changes in liver stiffness and steatosis as determined by MRI in patients with chronic HCV genotype 1 or 2 infection who received direct-acting anti-viral therapy and achieved SVR is investigated, read the article here....
Screening & Treating HCV
HCV From Screening to Cure
Treatment of Hepatitis C virus (HCV) infection has evolved from interferon (IFN)-based treatments to direct-acting antivirals (DAAs). Patients with HCV have an elevated psychiatric morbidity (including substance abuse) and patients with such comorbidity have often been excluded from treatment with IFN. To date, little is known about psychiatric adverse effects of DAA-based regimens. We therefore aimed to study the psychiatric side effects of new IFN-free treatment for HCV (including depressive symptoms and sleep) in real world patients also including those with a history of psychiatric diagnosis, substance abuse or drug dependence, read the article here....
The Truth about Hepatitis C Treatment long term Side Effects
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of liver disease through a series of informative videos, topics include ascites, hepatic encephalopathy and other liver-related complications.
Here is the latest video: The Truth about Hepatitis C Treatment long term Side Effects. AASLD Special Collection: Treating Liver Disease in 2018
Topics include: Hepatitis C virus reactivation in patients receiving cancer treatment, drug‐drug interactions in hepatitis C virus treatment and more. Start here...…
Fatty Liver
Journal of Gastroenterology and Hepatology
Special Issue: Burden of Nonalcoholic Fatty Liver Disease in Australia.
In this review, we present available data on the prevalence of NAFLD in Australia, its associated health burden in terms of hepatic and extrahepatic complications, common presentations, and evidence‐based therapeutic options. We also outline a research agenda highlighting gaps in knowledge that are needed to improve diagnosis and management of people with NAFLD specific to the Australian context. Full-text available here..... Behind The Headlines
Most multivitamins and supplements are a 'waste of money'
The review found that taking the most widely used supplements – multivitamins, vitamin D, vitamin C and calcium – had no significant effect on the risk of heart-related illnesses. And some supplements, such as vitamin B3 (niacin) may do more harm than good, read it here....
HIV
A new edition of our 'Antiretroviral drugs chart' is now available online. This one-page reference guide lists all the anti-HIV drugs licensed for use in the European Union, with information on formulation, dosing, key side-effects and food restrictions, read it here ….
The Controversy
Do direct acting antivirals cure chronic hepatitis C?
A controversial review by the Cochrane Collaboration published June 6, 2017/updated September 8 2017, cast doubt on the effectiveness of new hepatitis C treatments, on May 12, 2018, BMJ published; Do direct acting antivirals cure chronic hepatitis C ? by Cochrane author Janus Christian Jakobsen. BMJ talk medicine also aired a follow-up podcast with Jakobsen; New antivirals for Hepatitis C - what does the evidence prove? On May 16, 2018 experts weighed in on the program, read what they had say: Experts Respond To Latest BMJ Article: Do direct acting antivirals cure chronic hepatitis C? June Newsletters HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education. Newsletter June Issue We are continuing our conference coverage of the International Liver Congress 2018 and we have the following posters and presentations:
More of Lucinda’s Highlights from the 2018 International Liver Congress:
STUDY Abstract: THU-099 Lowering the upper limit of serum alanine aminotransferase levels may detect significant liver disease in the elderly – H. Schmilovitz-Weiss, et al.
STUDY Abstract: THU-100 Hepatitis C patients with HIV co-infection demonstrate unique liver-related complications and health behaviors compared to HCV mono-infected patients – M. Lu, et al.
STUDY Abstract: THU-399 Incidence and prevalence of extrahepatic manifestations of HCV – H. El-Serag, et al.
STUDY Abstract: THU-418 Lymphomas incidence in HIV/HCV coinfected versus HIV monoinfected patients over twenty-one years of follow up (1993–2014) – A.M. de Cea, et al.
STUDY Abstract: FRI-368 Long-term immunological and clinical impact of HCV eradication with directacting antivirals in patients with HCV-associated cryoglobulinemia vasculitis – M. Bonacci, et. al.
STUDY Abstract: THU-412 Among 1945–1965 birth cohort patients with at least one additional hepatitis C virus risk factor, one in eight were positive for HCV antibody: an underserved safety-net population experience – G. Hirode, et. al.
STUDY Abstract: THU-429 Strong increase of acute HCV infections in HIV-negative men having sex with men – L. Cotte, et. al.
More of Alan’s Highlights from the 2018 International Liver Congress:
STUDY Abstract: GS-018 Long-term follow-up of patients with chronic HCV infection and compensated or decompensated cirrhosis following treatment with sofosbuvir-based regimens – A. Mangia, et. al.
STUDY Abstract: LBO-008 A phase 3b, open-label, randomized, pragmatic study of glecaprevir/ pibrentasvir +/− ribavirin (RBV) for HCV genotype 1 subjects who previously failed an NS5A inhibitor + sofosbuvir (SOF) therapy – A. Lok, et. al.
STUDY Abstract: THU-121 Track, Trace & Treat: Results from a retrieval strategy to identify lost to follow-up chronic hepatitis c patients – I. Munsterman, et. al.
STUDY Abstract: LBP-0231 The percentage of patients with HCV infection in need of a liver transplant is rapidly declining while their survival after transplantation is improving: a study based on European Liver Transplant Registry – G. Perricone, et al.
STUDY Abstract: FRI-028 Liver transplant waitlist mortality, transplantation rates and post-liver transplant outcomes in Hispanics – P.J. Thuluvath, et al.
STUDY ABSTRACT: FRI-374 The impact of sustained virologic response on severe fatigue in patients with chronic hepatitis C: the role of HCV viremia and co-morbidities – Z. Younossi, et. al.
STUDY Abstract: THU-075 hepatitis C screening within the National Elimination Program in the country of Georgia – A. Gamkrelidze, et. al.
BRIEFLY…
STUDY Abstract: THU-075 hepatitis C screening within the National Elimination Program in the country of Georgia – A. Gamkrelidze, et. al.
STUDY Abstract: THU-104 The first result from the general population hepatitis screening in Mongolia: 38% of 40– 65-year-olds screened and anti-HCV prevalence of 15.6% among 40– 65-year-olds – B. Dashtseren, et. al.
STUDY Abstract: PS-090 Direct-acting antiviral treatment in sub-Saharan Africa: A prospective trial of ledipasvir/ sofosbuvir for chronic hepatitis C infection in Rwanda (The SHARED Study) – N. Gupta, et. al. Hepatitis Materials Available: We have a limited supply of free materials available. They are pre-packaged in the following quantities:
A Box of 1,500 Palm cards
A box of 1,000 Palm cards, 500 Baby Boomer postcards, & 500 website cards.
Please email us at Rosanne1956@hotmail.com if you have a need for materials to distribute.
Pack Health Don’t forget to check out Pack Health: a free resource to help patients navigate their HCV treatment journey from applying for treatment to cure.
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Use promo code: HCV2017
Get 3 months of membership free! As easy as 1-2-3!
Questions? Call us at 885-255-2362 8am-5pm | Monday-Friday
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• Use the tools and guides we send you to track your progress.
Hep - Your Guide to Hepatitis Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and HepMag.com are the go-to source for educational and social support for people living with hepatitis.
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to work on projects in order to meet needs identified by the community.
View all: Hep Free NYC Newsletters
HCV Action HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.
View recent newsletters Healio: International Liver Congress 2018 HCV Next is a monthly publication offering patients the latest research, news and commentary on liver disease and viral hepatitis, published online at Healio.
Read a nice summary of the liver meeting in the May/June issue.
World Hepatitis Alliance
We run global campaigns, convene high-level policy events, build capacity and pioneer global movements, ensuring people living with viral hepatitis guide every aspect of our work.
Read all updates Newsletters - World Hepatitis Alliance (WHA) presents hepVoice, a monthly magazine with updates on the latest projects, news from WHA members and key developments in the field of hepatitis.
GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online.
View all updates here.... Weekly Bull HepCBC is a Canadian non-profit organization offering awareness with basic information about HCV and a weekly digest of news.
Read the highly successful Weekly Bull. Pacific Hepatitis C Network (PHCN)
Welcome to the Pacific Hepatitis C Network (PHCN)‘s Hepatitis C News in Review Newsletter. This is where we review all of the major current issues and events around hepatitis C and hep C treatments. It is an email that includes links to our recent blog posts—including links to blog posts about Public Health Agency of Canada funding.
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CanHepC - Canadian Network on Hepatitis C CanHepC is a collaborative research network funded by the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC) dedicated to translational research linking over 100 researchers, trainees, knowledge-users (community members, community-based organizations, policy and decision makers) in the field of Hepatitis C (HCV) from across Canada as well as international partners.
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Hepatitis Victoria Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis. GOOD LIVER MAGAZINE is our quarterly newsletter, providing in-depth articles, interviews and reports, as well as detailing upcoming events, support groups, liver clinics, and other items likely to be of interest to our members. HepChat is our monthly electronic newsletter sharing news and information about hepatitis and the projects and activities we're working on, subscribe to HepChat. We also produced short podcasts interviewing health experts and practioners on topics related to viral hepatitis - come have a listen!
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Hepatitis A - Voice of San Diego
Voice of San Diego is an award-winning nonprofit news organization based in San Diego, California.
The Hep A Fallout Continues: On this week’s San Diego Explained, Voice of San Diego’s Jesse Marx and NBC 7’s Monica Dean take a look back at San Diego’s response to last year’s hepatitis A outbreak, listen here.
National Institutes of Health
A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services June Newsletter
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Healio
Healio staff will report live on breaking news presented at the meeting and capture video interviews with experts to gain their perspectives on important presentations.
Free registration may be required
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).
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
The site is free, and offers easy to comprehend learning activities with comprehensive information about diagnosing, monitoring and managing the virus.
In addition, check out the links below with an overview of FDA-approved drugs, including prescribing information, clinical studies, and slide decks, also provided by Hepatitis C Online. Finally, have a look see at the HCV Guidance to discover more about treating HCV according to your genotype.
The American Association for the Study of Liver Disease and Infectious Diseases Society of America (AASLD-IDSA) notes that evidence clearly supports treatment of nearly all persons with chronic HCV infection. Decisions regarding initiating therapy will naturally be influenced by the patient's willingness and readiness to undertake treatment.
Summary Points
Availability of highly effective, convenient, safe, well-tolerated therapy has changed the landscape for the treatment of hepatitis C.
Nearly all patients with hepatitis C may benefit from therapy. Those patients with a severely limited lifespan (less than 12 months) are the exception.
The decision and timing for starting HCV therapy needs to be individualized.
In situations when treatment is deferred (for whatever reason), the patient should periodically undergo reevaluation for disease progression and reconsideration of treatment, with the frequency of reevaluation individualized based on the patient's current fibrosis stage, likely fibrosis progression rate, and other factors that may influence treatment readiness.
The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV. Here are a few links to get you started.
