It’s hard to believe that the end of the year is near and the HCV Advocate newsletter is entering its 21st year of publication. This month we have devoted the entire issue to coverage of The Liver Meeting recently held in San Francisco, CA. Lucinda Porter, RN and I are reporting on our favorite posters presented at the meeting. Listed below are the abstracts that we have covered.
#584 Early Treatment with Direct-Acting Antivirals (DAAs) Saves Medical Costs in Non-Cirrhotic Patients with Chronic Hepatitis C (CHC) Virus Infection in the United States (US)- Patrice Cacoub, et. al.
Summary: In this review, the authors discuss the challenges in the development of a fully protective vaccine against the hepatitis C virus (HCV). The obstacles include overcoming how quickly the HCV mutates or changes its genetic make-up, the limited animal models available to test an HCV protective vaccine and our limited understanding of the HCV immune response. The authors conclude that these obstacles will need to be overcome to develop an effective protective vaccine in order to effectively eliminate HCV. It is unlikely that a protective vaccine will be developed in the very near future but progress is being made.
Title: Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: a modeling study—J.A. Kwon, et. al.
Summary: This study evaluated the likelihood that Australia would reach their target goal to eliminate HCV by 2030. Using a mathematical model to simulate the epidemiology and death rates in Australia over the period 2016-2030. Australia had a very fast rate of people who initiated direct-acting antiviral therapy (DAA) in 2016 with 32,600 people treated. It should be noted that the Australian government subsidizes the cost of HCV medications.
In their analysis, Australia should meet the WHO target of HCV elimination of 10 to 15 years. However, the authors noted that due to the number of people who already had HCV disease progression prior to the beginning of the approval of DAA therapies, it would be difficult to achieve the WHO target mortality or deaths.
Title: Eight-week hepatitis C treatment with new direct-acting antivirals has a better safety profile while being effective in the treatment-naïve geriatric population without liver cirrhosis and hepatitis C virus-RNA < 6 Million IU/mL—B. Yanny, et. al.
Study Aims and Results: Currently, eight weeks of Harvoni (ledipasvir plus sofosbuvir) is the recommended treatment period for people with hepatitis C (HCV) genotype 1, treatment naïve, without cirrhosis and who have an HCV viral load less than 6 million. The goal of the study was to find out if the recommended eight-week treatment duration can be applied to people over 65 years old.
A total of 454 patients were enrolled in the study—82 patients were treated for eight weeks, and 272 patients were treated for 12 weeks. The two groups were evenly matched for sex and age. All of the people were over 65 years old.
The cure rate in the 8-week group was 93% vs. 95% in the 12-week group. Eight-weeks of Harvoni was found to be safe, better tolerated and as effective compared to the 12-week Harvoni treatment group. As expected, the costs and treatment-related side effects in the 8-week treatment group were lower compared to the 12-week treatment group.
Conclusion: Treating people over 65 years old for eight weeks using the same patient characteristics as people treated for 12 weeks is as effective, produced fewer side effects, and is cost-effective.
Editorial Comments: This study showed that people over 65 years old could reap the benefits of an eight-week treatment of Harvoni.
A shorter treatment period will help to reduce side effects and increase medical insurance approval. Since people over 65 years old are more likely to take more medications, I would like to understand what benefit this would have for these persons.
Study Aims and Results: In the United States, there are an estimated 22 million users of marijuana. The current study reviewed previous studies (meta-analysis) to estimate the prevalence, and fibrosis disease progression.
The authors reviewed databases through November 2017 to evaluate the role of marijuana in chronic liver disease.
There were nine studies with 5,976,026 patients identified. The studies included two studies on people with nonalcoholic fatty liver disease (NAFLD), four hepatitis C virus (HCV) studies, and one HCV and HIV coinfection study.
In their analysis, marijuana use did not increase the prevalence or fibrosis progression in HCV or HCV/HIV coinfection patients. However, in patients with NAFLD, there was a reduction in fibrosis progression.
Conclusions: The authors found that marijuana did not increase the risk of fibrosis progression in people with HCV or HCV/HIV coinfection, but it had the opposite effect in people with NAFLD to reduce fibrosis progression.
Editorial Comments: In our HCV training workshops, the question of smoking or ingesting marijuana was a frequent topic of discussion. The trouble with a review of this type is that it doesn’t completely answer important questions. A well-designed study that looks at the potency, how much is ingested daily and many other factors need to be studied and answered before we can determine the question of safety in these patients with liver disease. Until we have more concrete studies on the effect of marijuana on the whole body, we do have this information to offer some reassurance.
Hepatitis C eroded Mike Jones’ liver for years, even as he made repeated trips to the Kansas City VA Medical Center to be treated for a variety of other ailments.
VA staff members knew that Jones had hepatitis C. They’d known since at least 2006. But according to a lawsuit, from 2012 to 2015, Jones didn’t get any of the regular scans or ultrasounds that patients with the condition should get. He also didn’t get drugs approved in 2014 that are highly effective at curing it.
By the time the VA staff realized Jones had fallen out of the regular treatment protocol, his condition had deteriorated into fatal liver cancer, according to the suit filed on behalf of Jones’ daughter.
HONG KONG — Researchers said Wednesday they have found a second patient in Hong Kong who contracted a strain of hepatitis carried by rats, in what appears to be the first known human cases in the world. The finding surprised the researchers, though it wasn’t immediately clear whether there were significant implications for human health.
“Because the rat … strain is very different from the human strain, people think it wouldn’t be able to jump to humans,” said Siddharth Sridhar, one of the principal researchers at Hong Kong University. “This was a clinical discovery.”
The first case came out in September. Researchers confirmed a 56-year-old man had a hepatitis E strain previously known only in rats in Vietnam. Doctors later found he had a strain of hepatitis that was “highly divergent” from other strains found in humans, BBC News reported.
First Human Case of Rat Hepatitis Found in Hong Kong
BBC News, Sept. 28, 2018
For weeks, this headline dominated the hepatitis-related news. Photos of rats accompanied the story of a 56-year-old Hong Kong man who developed the world’s first known human case of rat hepatitis E. In short, previously this hepatitis E strain did not infect humans. It isn’t known how the man contracted the virus, but garbage bins outside his home were infested with rats. It is possible that food or water were contaminated by rat droppings.