Tag: hepatitis

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

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.

06 Feb 2018

HCV and Children

Hepatitis C screening programs and treatment outreach tend to focus on three key populations: Baby Boomers, IV drug users, and prison populations. This is understandable, since rates of infection are notable in these high-risk groups. However, children infected with the hepatitis C virus (HCV) deserve attention, too. Of the more than 4 million people with HCV in the United States, approximately 250,000 of them are children.

For children, the likely route of infection traces back to mother-to-child transmission from HCV-infected pregnant women. The higher the mother’s viral load, the higher the risk of infection for her child. The infection can be spread whether birth is vaginal or C-section, since the virus from the mother’s body can cross the placenta to the fetus. In fact, up to 10% of children born to mothers with HCV will be infected with this chronic and life-threatening virus. A common scenario is for the mother to be an IV drug user, which can complicate the diagnosis of the child, if the parent does not pursue testing for the child. The screening test for HCV is not accurate until the infant is 18 months old, since HCV-related antibodies from the mother can stay in the blood of an infant for that long, even if the child does not have an infection.

There are fewer HCV medications approved for use in children, compared to the number of medications approved by the FDA for adults. But the positive news here is that there are approved medications for this young population. Hepatitis C does not need to be a death sentence, and certainly not so in children.

Source

Kukielka E. Researchers consider hepatitis C vertical transmission rates. MD MagazineJanuary 14, 2018.