Posts filed under ‘Hepatitis C’

Eliminating viral hepatitis: time to match visions with action

Lancet  November 11, 2017  V.390 N.10.108 P.2121

EDITORIAL

Eliminating viral hepatitis: time to match visions with action

 

PDF

http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32856-8.pdf

 

 

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November 10, 2017 at 4:02 pm

The road to elimination of hepatitis C: analysis of cures versus new infections in 91 countries

Journal of Virus Eradication July 2017

Andrew M Hill1* , Sanjay Nath2 , Bryony Simmons2

1 Department of Translational Medicine, University of Liverpool, UK

2 Faculty of Medicine, Imperial College London, UK

Abstract

Background

Hepatitis C (HCV) can only be eradicated if annual rates of cure (SVR) are consistently and significantly higher than new HCV infections, across many countries. In 2016, the WHO called for a 90% reduction in new HCV infection by 2030. Direct-acting antivirals (DAA) can cure the majority of those treated, at around 90% in most populations, at potentially very low prices. We compared the net annual change in epidemic size across 91 countries using data on SVR, new HCV infections, and deaths. In a further 109 countries, we projected this figure using regional averages of epidemic size.

Methods

Epidemiological data for 2016 were extracted from national reports, publications and the Polaris Observatory. There were 91/210 countries with data on SVR, HCV-related deaths and new infections available for analysis; 109 countries had net change in epidemic size projected from the regional prevalence of HCV, extrapolated to their population size. ‘Net cure’ was defined as the number of people with SVR, minus new HCV infections, plus HCV-related deaths in 2016.

Results

For the 91 countries analysed, there were 57.3 million people with chronic HCV infection in 2016. In the remaining 109 countries, the projected epidemic size was 12.2 million, giving a global epidemic size of 69.6 million. Across the 91 countries, there was a fall from 57.3 to 56.9 million people in 2017, a 0.7% reduction. The projected global net change was from 69.6 to 69.3 million, a 0.4% reduction. Ten countries had at least five times more people reaching SVR than new HCV infections, including Egypt and USA. In 47/91 countries, there were more HCV infections than SVR in 2016.

Conclusion

Very few countries are on target to achieve elimination of HCV as a public health problem by 2030. While the North American, North African/Middle East and Western European regions have shown small declines in prevalence, the epidemic is growing in sub-Saharan Africa and Eastern Europe. Far higher rates of DAA treatment are required for worldwide elimination of HCV.

FULL TEXT

http://viruseradication.com/journal-details/The_road_to_elimination_of_hepatitis_C:_analysis_of_cures_versus_new_infections_in_91_countries/

September 25, 2017 at 8:21 am

Editor’s Choice: Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don’t Change a Thing

Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.92-99

Susanna Naggie, David P. Holland, Mark S. Sulkowski, and David L. Thomas

1Duke Clinical Research Institute

2Duke University School of Medicine, Durham, North Carolina

3Emory University School of Medicine, Atlanta, Georgia

4Johns Hopkins School of Medicine, Baltimore, Maryland

Currently, 380 000–400 000 occupational exposures to blood-borne pathogens occur annually in the United States. The management for occupational HIV or hepatitis B virus exposures includes postexposure prophylaxis (PEP) when necessary; however, PEP is not recommended for hepatitis C virus (HCV) exposures.

Recent approval of HCV direct-acting antivirals (DAAs) has renewed discussions as to whether these therapies could be used to prevent infection after exposure. There are no published studies addressing this question, but the prescribing of DAAs for PEP has been reported.

We will discuss the differences in transmission of the 3 most common blood-borne pathogens, the natural history of early HCV infection, and the scientific rationale for PEP.

In particular, we will discuss how the low feasibility of conducting an adequately powered clinical trial of DAA use for PEP and the low cost-effectiveness of such an intervention is not supportive of targeting limited resources for such use.

PDF

https://cid.oxfordjournals.org/content/64/1/92.full.pdf+html

 

 

Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.100-101

Editor’s Choice: Editorial Commentary: Decision Science at Work: The Case of Hepatitis C Virus Postexposure Prophylaxis

Joshua A. Barocas and Benjamin P. Linas

1Division of Infectious Diseases, Massachusetts General Hospital

2Boston University Schools of Medicine and Public Health

3Boston Medical Center, Massachusetts

In this issue of Clinical Infectious Diseases, Naggie et al discuss clinical decision making and present the results of a decision analysis examining the cost of hepatitis C virus (HCV) postexposure prophylaxis (PEP) among healthcare workers who experience a needlestick exposure to HCV-positive body fluids.

The authors discuss that, in an era when we can cure essentially all HCV infections, there are only 3 motivations for PEP. First, it may make sense to use PEP to prevent infections if doing so would decrease HCV transmission during the period of active HCV viremia. The paper succinctly reviews the evidence and quickly makes clear that among healthcare workers in the United States with a known HCV exposure, basic universal precautions reduce the risk of forward transmission to essentially zero.

A second motivation might be cost. Given that HCV medications are expensive, a shorter course PEP may be cost saving compared with full treatment for HCV infection. To address the possible economic rationale for PEP, the authors developed a decision tree to estimate the costs of PEP for HCV in a hypothetical cohort of 100 healthcare workers who had suffered a needlestick injury. They used the model to compare the outcomes with PEP to those with a strategy of “no PEP and treat only patients who develop chronic HCV infection.”

A few notable assumptions were made—namely, that PEP was 100% effective at preventing infection, while treatment for chronic HCV was only 98% effective with the first line of therapy. In addition, individuals who failed first-line treatment for chronic HCV infection were retreated with 100% . . .

PDF

https://cid.oxfordjournals.org/content/64/1/100.full.pdf+html

August 19, 2017 at 10:30 am

New hepatitis C antiviral treatments eliminate the virus

Lancet July 8, 2017 V.390 N.10090

Correspondence

Joseph S Doyle, Alexander J Thompson, Peter Higgs, Mark Stoove, Paul M Dietze, Margaret E Hellard

The Cochrane Collaboration has published a topical systematic review1 and meta-analysis on direct-acting antivirals (DAA) for chronic hepatitis C virus (HCV) infection.

Jakobsen and colleagues1 compared the results of randomised trials of any HCV DAA regimen versus no intervention or placebo.

Their review reported data from 138 trials, which included 25 232 participants and encompassed all drugs on the market or under development.

The authors confirm treatment has a significant benefit (relative risk 0·44, 95% CI 0·37–0·52, p<0·001), compared with no treatment, in the elimination of the virus from the bloodstream, measured 12–24 weeks after treatment (sustained virological response, SVR); however, they conclude there was “insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV” and that although DAAs might increase SVR, “the clinical implication of the results on this non-validated surrogate outcome is unclear”…..

FULL TEXT

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31817-2/fulltext?elsca1=etoc

PDF

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)31817-2.pdf

July 7, 2017 at 8:04 am

Guidelines – Recommendations on hepatitis C screening for adults

Canadian Medical Journal Association April 24, 2017 V.189 N.16

Canadian Task Force on Preventive Health Care

An estimated 0.64%–0.71% of Canadians (220 000–245 000 people) have chronic hepatitis C virus (HCV) infection,1 and approximately 44%2 of those may be undiagnosed. HCV can be transmitted directly through percutaneous exposure (e.g., through inadequately sterilized medical equipment) or through receipt of contaminated blood products.3 People who inject drugs are at highest risk, but recipients of unscreened blood products, tissues or organs and patients undergoing long-term hemodialysis are also at increased risk.3 Less common modes of transmission include vertical transmission, high-risk sexual contact, unsterilized tattoo or piercing equipment, and occupational exposure.3 Not all people with chronic HCV infection will develop cirrhosis or signs or symptoms indicative of liver disease.4 It is estimated that approximately 84% of people infected with HCV do not develop cirrhosis 20 years after acute infection, and 59% after 30 years.5,6 Progression of liver fibrosis is variable and influenced by factors such as alcohol consumption, age at time of infection, male sex and HIV coinfection.7

PDF

http://www.cmaj.ca/content/189/16/E594.full.pdf+html

May 9, 2017 at 3:35 pm

Guideline – Recommendations on hepatitis C screening for adults

Canadian Medical Association Journal  April 24, 2017  V.189  N.16

Canadian Task Force on Preventive Health Care

An estimated 0.64%–0.71% of Canadians (220 000–245 000 people) have chronic hepatitis C virus (HCV) infection,1 and approximately 44%2 of those may be undiagnosed. HCV can be transmitted directly through percutaneous exposure (e.g., through inadequately sterilized medical equipment) or through receipt of contaminated blood products.3 People who inject drugs are at highest risk, but recipients of unscreened blood products, tissues or organs and patients undergoing long-term hemodialysis are also at increased risk.3 Less common modes of transmission include vertical transmission, high-risk sexual contact, unsterilized tattoo or piercing equipment, and occupational exposure.3 Not all people with chronic HCV infection will develop cirrhosis or signs or symptoms indicative of liver disease.4 It is estimated that approximately 84% of people infected with HCV do not develop cirrhosis 20 years after acute infection, and 59% after 30 years.5,6 Progression of liver fibrosis is variable and influenced by factors such as alcohol consumption, age at time of infection, male sex and HIV coinfection …

PDF

http://www.cmaj.ca/content/189/16/E594.full.pdf+html

May 5, 2017 at 8:06 am

Role of Serologic and Molecular Diagnostic Assays in Identification and Management of Hepatitis C Virus Infection

Journal of Clinical Microbiology February 2016 V.54 N.2 P.265-273                 

Minireviews

Gavin Cloherty, Andrew Talal, Kelly Coller, Corklin Steinhart, John Hackett Jr., George Dawson, Juergen Rockstroh, and Jordan Feld

aAbbott Diagnostics, Abbott Park, Illinois, USA

bUniversity at Buffalo, Buffalo, New York, USA

cViiV Healthcare, Research Triangle Park, North Carolina, USA

dUniversity Bonn, Bonn, Germany

eUniversity of Toronto, Toronto, Canada

The drugs available for the treatment of hepatitis C virus (HCV) have evolved to provide shorter treatment duration and higher rates of sustained virologic response (SVR), and the role of HCV infection diagnostic tests has had to evolve in order to meet changing clinical needs. This review gives an overview on the role of HCV infection diagnostic testing (molecular and serological tools) used in the diagnosis and management of HCV infection. All of this critical information guides physician decisions to optimize patient clinical outcomes. Also discussed is the future direction of diagnostic testing in the context of further advances in drug development.

PDF

http://jcm.asm.org/content/54/2/265.full.pdf

April 9, 2017 at 7:23 pm

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