Source Abstract # THU-204 Understanding factors associated with hepatitis C spontaneous viral clearance: a meta-analysis –D. N. Aisyah et al.
Study Aims and Results
The study analyzed the rate of spontaneous or natural clearance of hepatitis C after becoming acutely infected. The authors reviewed various studies (meta-analysis) from several databases (Ovid Embase, Ovide Medline, Pubmed) from 1/1/1994 – 6/30/2015 to understand the time of acute infection to spontaneous clearance and the factors associated with spontaneous clearance. Forty-four studies of 20,409 people were included in the review.
Approximately 1/5 of those who cleared hepatitis C did so within 3 months, 1/3 did so in 6 months and over 1/3 did so in 12 months. If people did not clear the virus by 12 months they were unlikely to clear the virus.
The groups that were less likely to spontaneously clear the virus early in the acute phase included males, those who did not have a hepatitis B co-infection, who lacked hepatitis C symptoms, black race, non-genotype 1, older age, those with alcohol or drug use and people with HIV.
There are two important outcomes from this study:
1. It clearly shows that 12 months establishes the time period needed to ascertain the time to spontaneously clear the hepatitis C virus from the body in most people acutely infected with hepatitis C. But it is important to take note of the exceptions listed above. (see the abstract below to treat acute HCV in people with HIV for an example of why it’s important to treat sooner than the above date range.)
It gives a better understanding of who and when to treat with direct-acting antiviral therapy for those who have been recently infected with the hepatitis C virus.
Abstract # THU-200 High prevalence of concomitant substance abuse and mental health disorders in an urban underserved FQHC-based hepatitis C virus treatment program—A. Nateras et al. By Alan Franciscus
Study Aims and Results HCV treatment is seldom offered to injection drug users and people with mental health disorders. This is slowly changing with the availability of direct-acting antivirals (DAA) drugs. The current study describes the prevalence of mental health, substance use, and HCV DAA treatment in an urban underserved primary care network. Electronic health records from 23 urban community health clinics in San Diego (1/1/12 – 11/17/16) were reviewed that included people with positive HCV antibodies, HCV RNA (viral load), substance use, and mental health diagnoses according to ICD-10 codes (The International Classification of Diseases). All of the patients were treated or awaiting treatment with DAAs.
Conclusion A total of 3,233 people were HCV RNA (viral load) positive—of these 435 (13%) were already on treatment or had finished treatment. In the total group of HCV RNA positive 891 (28%) had substance use disorders, 403 (12%) had mental health disorders, 1,220 (38%) had both substance use and mental health disorders; 718 (22%) had neither disorder. In the group of treated people (n=435), 287 (66%) had substance use disorders, 221 (51%) had a mental health disorder, 186 (43%) had both mental health and substance disorders and 93 (21%) had none of the disorders. The most common type of diagnoses were depression (140 people-32%), drug use disorder in remission (55 people-2%), alcohol remission (45 people-1%). In the treated population the most common diagnosis was a psychotic disorder (58 of 435 people-13%). Of those with a substance disorder—more than half were in remission. The authors commented that the percentage of patients with substance and mental health disorders was similar between those on and off HCV treatment.
Editorial Comments As this study points out, there is no reason that people who inject drugs or who have mental health disorders should be denied HCV treatment.