Tag: hepatitis c

04 Sep 2018

The Latest Word in HCV Treatment

New guidelines for treating hepatitis C infections came out from the World Health Organization. These replace and update WHO’s 2016 recommendations. Certainly a lot has changed in just the past three years – all of it comes as great news for anyone carrying the hepatitis C virus (HCV).

The key take-away from these comprehensive new guidelines (all 108 pages of them!) center on one game-changing strong recommendation:

  • Hepatitis C treatment should be offered to all people age 12+ (except pregnant women) with chronic hepatitis C infection, regardless of their disease stage.

In other words, treatment should not be delayed until the disease causes more serious health consequences. Treat HCV early and treat everyone.

A second big change to HCV recommendations relates to selecting a treatment:

  • Direct-acting antivirals, which work on all six major genotypes of HCV, should be used.

Since these types of medications effectively treat all types of HCV, it is no longer necessary to spend time and money on genotyping the infection (which previously was used to select the best treatment). The new course of action sums up as: get tested and get treated with one of the new direct-acting antivirals that work on all major forms of HCV.

WHO set a goal to eliminate viral hepatitis by the year 2030. It’s a tall order, but one that would save millions of lives. To achieve this goal, 90% of people who are infected need to get diagnosed with this disease (you can’t treat it if you don’t know you have it!) and 80% of people with a diagnosis need to be treated. So let’s get to it!

Source

World Health Organization. Guidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. July 2018. http://apps.who.int/iris/bitstream/handle/10665/273174/9789241550345-eng.pdf?ua=1

04 Sep 2018

Pregnancy and Hepatitis C

Hepatitis C and pregnancy have a complicated relationship. Pregnancy itself does not appear to worsen the course of hepatitis C infection and a woman should wait to be treated for the infection until after pregnancy. Of course, there is understandable concern of how a hepatitis C infection in a woman can affect her unborn child.

Ideally, any woman who has risk factors for hepatitis C infection (e.g., exposure to contaminated needles or injected drug use) would be screened for hepatitis C prior to or at least during the pregnancy. Many experts are now calling for universal screening of pregnant women, regardless of reported risk factors.

Overall, for every 100 pregnant women with hepatitis C, 6 of their babies will be born also infected with this disease. The chance that a pregnant woman will pass on the hepatitis C virus to her unborn child depends on how high the viral levels are in her body, along with whether or not she is also HIV-positive (which makes it more likely). In any event, a pregnant woman with hepatitis C should be under the care of a specialist who can keep a close eye on liver function tests throughout the pregnancy. And during the birth itself there are recommendations to minimize risk of vertical transmission, such as avoiding scalp monitors (which could cause bleeding). Interestingly, there is not a risk of transmission from breastfeeding.

After a baby is born to an infected mother, the child should be tested at the age of 18 months for hepatitis C. About 40% of exposed children will clear the virus on their own without treatment, while the rest will require medication to treat the hepatitis C infection. However, this treatment should not start until age 3 and there are now (fortunately) medications that can be used at these young ages. For the mother, she should be treated after —  not during – the pregnancy.

Sources

Dibba P, Cholankeril R, Li AA, et al. Hepatitis C in pregnancy. Diseases 2018;6(2):E31.

Cervino L, Hynicka LM. Direct-acting antivirals to prevent vertical transmission of viral hepatitis C: When is the optimal time to treat? Ann Pharmacother April 1, 2018 doi: 10.1177/1060028018772181

22 May 2018

HCV Testing and Treatment: The Time is Now

There are nearly 4 million Americans with chronic hepatitis C infections, yet only 9% of them have been successfully treated, according to some estimates. The gap between these numbers becomes more shocking when paired with the fact that current hepatitis C treatments have been shown to cure 94-98% of all hepatitis C virus (HCV) genotypes. In addition, even when second-line therapies are needed for patients who failed primary therapy, those therapies are effective in 96% of patients. In other words, almost all of HCV-infected Americans can be cured!

Treating HCV patients remains a high priority because when this disease continues unchecked, it often leads to liver cancer and liver failure. Curing patients of HCV reduces all-cause mortality from 26% down to 8.9%, not to mention the improvements patients experience in terms of quality of life, ability to work, and mental health.

There are two core demographic groups comprising most of today’s HCV infections: Baby Boomers and 20-29 year olds. The former tend to have been infected many years ago in their past while the latter are often associated with more recent opioid use.

A push for greater testing in both of these two groups is warranted. Evidence suggests that only half of those with HCV are aware of their infection status. Health care providers are at the front line for getting HCV-infected patients tested and treated, which is especially important for harder-to-reach people, such as IV drug users, patients in federally qualified health centers, and other urban and rural populations.

When it comes to hepatitis C, now is clearly the time for both testing and treatment. Rely on BioPlus for the latest information in current treatments and ways to connect patients to funding sources to access treatment.

Source

Kerr CA, Aron JS. Treating chronic hepatitis C infection: A call to action for primary care providers. Medscape Jan 17, 2018.

20 Mar 2018

Hepatitis C and Diabetes: A Complicated Relationship

Guest blog by: Erica Yelton, Pharm.D., CSP, Pharmacy Center Manager, BioPlus Specialty Pharmacy

Hepatitis C and diabetes are both prevalent, global diseases with long-term implications in terms of morbidity and mortality. The World Health Organization reports that 170 million people are infected with hepatitis C and 347 million people suffer with diabetes. Most studies show that patients with hepatitis C are more susceptible to developing type 2 diabetes. It is estimated that up to 33% of chronic hepatitis C patients have type 2 diabetes. The connection between these diseases is seen in both developed and developing countries. The central component of developing insulin resistance is the intense inflammatory response to the hepatitis C virus (HCV) which disrupts the insulin signaling pathway. Also, inflammation causes pro-inflammatory cytokines to be released causing damage to beta cells. Beta cells are the producers of insulin in response to glucose. Studies have shown that HCV can directly and indirectly induce beta cell dysfunction.

On the reverse side, patients with type 2 diabetes are at a higher risk for complications from HCV. Patients with HCV and insulin resistance have been shown to have significantly worse outcomes. Some of these include decreased SVR rate, increased progression of fibrosis and cirrhosis, and increased risk of hepatocellular carcinoma. When insulin is increased, which happens in those with insulin resistance, it stimulates hepatic stellate cells which produce nonfunctional matrix and scarring, AKA fibrosis. This occurs in a dose dependent fashion. Insulin resistance also causes increased release of fatty acids from adipose and increased lipid deposition both of which are associated with fibrosis. Patients with diabetes are also at an increased risk for various malignancies including hepatocellular carcinoma. Insulin, insulin-like growth factor, and chronic inflammation have all been implicated in carcinogenesis.

To further complicate the scenario, interferon, which was once the mainstay treatment for HCV, is now known to cause type 1 diabetes! Interferon is a known potent immunomodulator and can contribute to autoimmunity. In most cases studied of patients who developed type 1 diabetes, the onset occurred during or shortly after treatment with interferon. To date, there are greater than 45 known cases. It is important to suspect type 1 diabetes in patients who present with polydipsia and polyuria after treatment with interferon. Since treatment regimens now steer away from interferon, it may be that the rate of type 1 diabetes as a complication of treatment decreases.

On one hand, HCV triggers diabetes and on the other hand, diabetes worsens hepatitis C outcomes. It is recommended to screen for diabetes in all HCV-infected patient regardless of age or medical history and especially important in patients with known autoimmune conditions. The complicated relationship between these two disease states will have to be addressed until hepatitis C is eradicated and even then, the lasting effects of complications will still have to be dealt with.

Source: Hammerstad SS, Grock SF, Lee HJ, et al. Diabetes and hepatitis C: a two-way association. Frontiers Endocrin 2015;14(6):134.