This article by Dr. Ieva Tolmane et al. is published in The Open Infectious Diseases Journal, Volume 10, 2018
There has been published results of the study “ORIGINAL VERSUS GENERIC DIRECT ACTING ANTIVIRALS IN TREATMENT OF CHRONIC HEPATITIS C PATIENTS: REAL LIFE DATA FROM LATVIA” authored by Tolmane I, Rozentale B, Arutjunana S et al., recently.
There are many new highly effective direct acting antiviral medicines for hepatitis C treatment registered worldwide during recent years. Despite effective treatment available from 2016 in Latvia, there are restrictions – only patients with fibrosis (F, Metavir) stages 3 to 4 have access to reimbursed medicines. Some patients obtain generic drugs from India. The aim of this study was to evaluate the efficacy of original and generic direct acting antiviral medications in Latvian hepatitis C patients. This was a retrospective study of 179 chronic viral hepatitis C patients. Patients were divided into two groups – those who received original direct acting antivirals ombitasvir, paritaprevir, ritonavir, dasabuvir + ribavirin (n=144) and those who received generic medicines from India (n=35) sofosbuvir, ledipasvir or sofosbuvir, daclatasvir + ribavirin. Undetectable viral load 12 weeks after cessation of therapy (sustained virologic response 12) was measured in all patients. Therapy course completed 142 patients (2 patients discontinued treatment) from original medicines group and all patients from generics group. In the original medicines group – sustained viral response was achieved in all 142 patients who completed treatment course (100%), while in generic medicines group in 32 patients (91.4%).
Louisiana is working with Gilead Sciences and other companies on a deal that would change how the state pays for expensive hepatitis C drugs, with the goal of eliminating the disease in that state.
DAVID GREENE, HOST:
This week, NPR and the Center for Public Integrity have been reporting on lobbying by pharmaceutical companies in states across the country. We have found a system rife with conflicts of interest that make it hard for states to control costs in their Medicaid programs. But in Louisiana, one of the poorest states in the U.S., a deal is in the works that may change how the state pays for one very expensive medication that thousands of residents need. And in the long term, this deal could change how states and drug companies work together to rein in drug prices. Here’s NPR’s Alison Kodjak.
ALISON KODJAK, BYLINE: To get a sense of what happens when high drug prices and tight state budgets mix, Louisiana is the place to go. The state has been in a budget crisis. Lawmakers held three special sessions this year, and the Medicaid budget was a major target. Rebekah Gee is the state’s health secretary.
Study Aims and Results: The aim was to look at the relationship of the intestinal microorganisms in HCV patients compared to healthy people. Fecal (poop) sample was collected from 166 HCV patients and 23 healthy people and examined. The health status of people with HCV included normal ALTs (18 people), chronic hepatitis C without liver cirrhosis (84 people), liver cirrhosis (40 people), liver cancer (24 people). Compared to healthy people the bacterial diversity was lower in the people infected with hepatitis C. This occurred in various degrees in all stages of HCV disease progression.
Conclusions: Gut dysbiosis was diagnosed in people with hepatitis C regardless of the severity of liver disease.
Editorial Comments: Gut dysbiosis is implicated in a wide variety of disorders including inflammatory bowel disease, irritable bowel syndrome, and celiac disease. It may also include disorders outside of the intestines including allergies, metabolic syndrome, cardiovascular disease, and obesity.
Deaths from liver disease have risen sharply in the U.S., and doctors say the biggest factor is drinking —especially among young adults.
A study published Wednesday found a 65 percent increase in deaths from cirrhosis of the liver since 1999. The biggest increase is among millennials: the team found that deaths from cirrhosis are rising 10 percent a year among people aged 25 to 34.
People so young might not even realize that they can drink themselves to death so quickly, but they can, said liver specialist Dr. Haripriya Maddur of Northwestern Memorial Hospital in Chicago.
Article: Evaluation of the Xpert HCV Viral Load Finger-Stick Point-of-Care Assay – F.M.J. Lamoury, et. al.
Source: The Journal of Infectious Diseases, Volume 217, Issue 12, 25 May 2018, Pages 1889–1896, https://doi.org/10.1093/infdis/jiy114
Study Aims and Results: The finger-stick viral load assay results can be given in 1 hour, allowing for a single visit HCV diagnosis after a positive HCV antibody result. The aim was to test the reliability of an HCV RNA (viral load) finger-stick assay compared to the blood draw assay. There were two arms in the study—an HCV viral load negative group of 125 people (comparator arm) and an HCV positive viral load group of 85 people (study arm).
The study tested the sensitivity (to correctly identify those with the disease) and specificity (to correctly identify those without the disease) by blood draw compared to finger prick.
Conclusions: The Xpert HCV Viral Load Finger-Stick Point-of-Care Assay is a reliable HCV viral load assay that provides 100% accuracy.
Editorial Comments: Currently, people who test HCV antibody positive have to return for an HCV viral load test or if they have a blood draw for a viral load test they have to return later for the results. If a patient has to return for the results, it can lead to patient anxiety, and patients may be lost to follow-up. The Point-of-Care finger stick diagnostic test will help to diagnose active HCV infection immediately, eliminate the need for a blood draw, provide immediate medical care, counseling, and follow-up care. Finally, it will be another tool to help eliminate HCV.
The National Viral Hepatitis Roundtable (NVHR) will be hosting a hepatitis C (HCV) patient summit in early 2019. The summit, NVHR’s first national patient gathering, will bring together 100 patients recently cured of or currently living with HCV who have not had experience engaging in other advocacy programs.
By establishing a platform for 100 HCV patients to engage in dialogue, NVHR will work with participants to develop shared goals as well as address the need for greater patient engagement and leadership to ensure the delivery of high quality of care for patients diagnosed with HCV. To ensure the demographics of attendees reflect the demographics of the HCV epidemic, the patient summit will emphasize recruitment of individuals from disproportionately impacted and marginalized communities.
The summit Planning Committee is comprised of 8 members who have lived experience of HCV and are engaged in patient advocacy. These members are providing oversight and helping NVHR staff execute the summit: Chris Abert, Dan Berrner, Ronni Marks, Peter McLoyd, Gloria Searson, Robin Lord Smith, Alicia Suarez, and Louise Vincent.