Abstract #163 The Opioid Epidemic and Infectious Diseases: A Public Health Crisis – Sally Hodder
Summary: In the United States in 2016, there were more than 60,000 drug overdose deaths plus nearly 20,000 additional deaths from viral hepatitis. The number of acute hepatitis C cases has increased nearly 3-fold from 2010 to 2015; acute hepatitis B has increased 20%. Opioid-related infections are emerging at epidemic proportions.
Editorial Comments: This last abstract was more of a data review and call to action than a study. I included it because these days, hepatitis C will not be eliminated without addressing the opioid crisis. Click here to read the entire abstract.
Abstract #609 Predictors of Lack of Hepatitis C Eradication Using Direct-Acting Antivirals – Edward R. Cachay, et al.
Study Aims and Results: This retrospective study sought to identify factors involved in the lack of sustained viral response (SVR) following DAA treatment among people living with HIV (PLWH). Data from the U.S., Spain, and Italy were gathered from 2014 to 2017. Researchers analyzed 450 PLWH looking at: demographics, HIV regimen, CD4, and viral load, HCV-genotype (GT), prior treatment history, and DAA used, fibrosis stage, cirrhosis, and prior liver decompensation. They also looked at comorbidities, active alcohol, illicit drug use, unstable housing and active psychiatric illness.
Overall, 415 patients (92.2%) achieved SVR. Of the 35 failures, 23 were HCV relapses, 9 were lost to follow-up, 2 discontinued DAA therapy due to side effects, and 1 stopped due to a severe comorbidity. Active psychiatric illness was associated with lack of SVR.
Conclusions: Among PLWH, active psychiatric illness was independently associated with lack of SVR to DAA. The researchers recommend exploring the role of drug adherence and/or drug interactions in this population.
Editorial Comments: People with psychiatric illnesses are often left out of studies. I particularly appreciate the researchers’ recommendations about exploring the role of drug adherence and/or drug interactions in people with psychiatric illness.
Abstract #579 Very Low Hepatitis C Viral Loads in Absence of Therapy: Impact on HCV Antigen Testing – Barbara Bertisch, et al.
Study Aims and Results: HCV antigen testing is a less expensive alternative to viral load testing. However, antigen testing has difficulty detecting very low viral loads (≤ 3,000 IU/ml). This Swiss study assessed the prevalence and analyzed predictors of very low viral loads (VLVL) in 2,460 treatment-naïve participants.
Overall, 5.3% had at least one VLVL. The factors most associated with VLVL are ≤ 40 years old. Gender, HCV genotype and intravenous drug use were not associated with VLVL. Participants with VLVL had a higher rate of spontaneous clearance than those without VLVL. There were 24 cases of cirrhosis, all with either excessive alcohol consumption, HIV coinfection, organ transplantation or other immunosuppressive conditions. The mortality rate was comparable to those without VLVL.
Conclusions: The occurrence of very low viral loads is low. Although the rate of spontaneous clearance is better than expected, the incidence of cirrhosis is disturbing. The use of the HCV antigen assay is questionable as a single tool for HCV detection.
Editorial Comments: Although HCV antigen testing is not the standard assay used in the U.S., this research about very low viral loads is important. Click here to read the entire abstract and view the poster.
Abstract #606 High Efficacy of 8 Weeks of Ledipasvir/Sofosbuvir in African Americans with HCV – Whitney Nichols, et al.
Study Aims and Results: Current HCV guidelines (www.hcvguidelines.org) recommend that African Americans with genotype 1 HCV receive 12 weeks of ledipasvir/sofosbuvir (LDV/SOF), even if they meet criteria for 8 weeks. Research shows conflicting results of treatment outcomes in this group. This retrospective study evaluated the efficacy of 8 weeks of LDV/SOF in African Americans in a real-world setting.
Using data from 2014 to 2017, researchers analyzed data from 59 participants, comparing age, fibrosis level, gender, genotype, medication/treatment adherence, and use of acid-reducing medicines. When comparing 8 weeks to 12 weeks of treatment, they found no significant differences between groups regarding age, genotype, medication and appointment adherence and acid-reducing medication use. However, there were more females, earlier liver fibrosis, and lower baseline viral loads in the 8-week group.
Conclusions: In a real-world setting, 8 weeks of HCV treatment showed good results in African Americans.
Editorial Comments: This study is small and retrospective. I would not rely on these findings to make treatment decisions. I hope we see some large prospective research on this subject. Click here to read the entire abstract and view the poster.
Abstract #600 Increasing Incidence of Denial of DAA Therapy for Chronic HCV by Insurance Type – Charitha Gowda, et al.
Study Aims and Results: When HCV direct-acting antivirals (DAAs) were first approved, insurers restricted access because of the high cost of medications. Looking for information about current practices, this prospective study analyzed access to HCV treatment between January 1, 2016 and April 30, 2017. Using a national specialty pharmacy, researchers collected data from 9,025 people from 45 states who were prescribed a DAA regimen (4,702 covered by Medicaid; 1,821 by Medicare; 2,502 by commercial insurance). There were 3,200 (35.5%) absolute denials. Absolute denial was more common among patients covered by commercial insurance (52.4%) than by Medicaid (34.5%) or Medicare (14.7%). Analyzing quarterly data, denial of treatment increased per quarter from 27.7% in the first quarter to 43.8% in the last quarter.
Conclusions: Despite the fact that HCV has a high cure rate, treatment denials are high and appear to be increasing.
Editorial Comments: This is outrageous and inhumane. The only way HCV can be eliminated is to improve access to care. Click here to read the entire abstract and view the poster.