Category Archives: Elimination of HCV

Among Cirrhotic Patients with a Hepatitis C Sustained Viral Response, the Risk of De-novo Hepatocellular Carcinoma Relates to Baseline Factors and Not the Use of Direct Acting Antivirals: Results from a Nationwide Cohort—H. Innes et al.

Source: PS-035 Among Cirrhotic Patients with a Hepatitis C Sustained Viral Response, the Risk of De-novo Hepatocellular Carcinoma Relates to Baseline Factors and Not the Use of Direct Acting Antivirals: Results from a Nationwide Cohort—H. Innes et al.

Study Aims and Results: The current study is a retrospective study (looking back over time) from the period of 1997 to 2017. Importantly, there were no cases of liver cancer prior to treatment in the patients.  The patients in the study were treated previously with interferon-based therapies (585 pts) or direct-acting antiviral therapies (272 pts).  The patient characteristics included mostly white (92%), male (75%), current smokers (73%), history of IDU (70%) and heavy alcohol users (44%). Nine percent of the interferon-based group and 30% of the interferon-free group had moderate to severe cirrhosis.

Conclusions: The number of people who developed liver cancer in the interferon-based group was 34 (5.8%) and 12 (4.4%) in the direct-acting antiviral (DAA) group. The study didn’t find a difference in the occurrence of liver cancer rates after achieving a cure with an interferon-based therapy or a direct-acting antiviral medication. It is still important that people who are cured and have cirrhosis are followed closely after being cured because liver disease can progress.

Editorial Comments: There are many studies that are looking at disease progression and liver cancer occurrence and reoccurrence after being cured of hepatitis C.  Most studies have found that being cured of hepatitis C reduces the risk of serious disease progression, liver cancer and death.  Some studies have found a faster disease progression, however, the studies are in the minority.  A good recap of studies of liver cancer recurrence was included in a press release issued by the International Liver Conference/EASL.  I have included a press release from EASL that details both types of studies for our readership to read and digest. To read click here

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Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting?

Editorial Comments:  This abstract that provides information about lowering the incidence of hepatitis C among people who inject drugs in Athens, Greece.

 Article:  Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting?—I Gountas et al.

Source:  Addiction. 2017 Jan 20. doi: 10.1111/add.13764. [Epub ahead of print]

AIMS:

To project the impact of scaling-up oral anti-viral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programmes to achieve specific targets and to examine whether hepatitis C virus (HCV) elimination among PWID is possible in this high-prevalence setting.

DESIGN:

A dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for re-infection following treatment.

SETTING/PARTICIPANTS:

The population of 8300 PWID in Athens Metropolitan area.

MEASUREMENTS:

Reduction in HCV prevalence and incidence in 2030 compared with 2016.

FINDINGS:

Moderate expansion of HCV treatment (treating 4-8% of PWID/year), with a simultaneous increase of 2%/year in harm reduction coverage (from 44 to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46.2-94.8% in 2030, compared with 2016. CHC prevalence would reduce to below 10% within the next 4-5 years if annual HCV treatment numbers were increased up to 16-20% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates.

CONCLUSIONS:

Based on theoretical model projections, scaled-up hepatitis C virus treatment and harm reduction interventions could achieve major reductions in hepatitis C virus incidence and prevalence among people who inject drugs in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4-5 years by increasing treatment to more than 16% of people who inject drugs per year combined with moderate increases in harm reduction coverage.

© 2017 Society for the Study of Addiction.

 

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