AASLD 2018: AASLD Presidential Poster of Distinction
Abstract: #588 Eradication of Hepatitis C Virus Infection by IFN-Free Direct-Acting Antiviral Agents Reduces Hepatocellular Carcinoma Incidence in Patients with Chronic Hepatitis C – Hitomi Sezaki, et. al.
The risk of hepatocellular carcinoma (HCC or liver cancer) after being cured with direct-acting antiviral (DAA) treatment is still a hotly debated topic. This retrospective study analyzed records of 1,928 people cured with DAA therapy to 2,394 untreated chronic HCV patients (control group). The patient health and liver cancer history were recorded.
The DAA group had a cure rate of 92%. There were 677 in each group (DAA group and untreated group-patient characteristic were evenly matched). It was reported that the rate of HCC (liver cancer) in the DAA group was 1% at year 2, 2.1% at year 3 and 3.1% at year 4 vs. 2.6% at year 2, 5.9% at year 3, and 9.3% at year 4 in the untreated group.
Conclusion: DAA therapy significantly reduced the incidence of HCC at year one through year four after being cured of HCV.
Editorial Comments: Boy do I wish I had more information about this study. I can’t wait to read the entire publication to learn more. I hope to share the information when published. Until that time, it’s information that should comfort those who are cured (or those who are contemplating treatment with DAAs) that being cured will reduce the chances of developing HCC. Be sure to check out Lucinda Porter’s article in the next issue of the HCV Advocate newsletter.
The largest population study of hepatitis C in Africa has found three new strains of the virus circulating in the general population in sub-Saharan Africa. The research from the Wellcome Sanger Institute, the MRC-University of Glasgow Centre for Virus Research and collaborators suggested that certain antiviral drugs currently used in the West may not be as effective against the new strains and that clinical trials of patients in sub-Saharan Africa are urgently needed to assess optimal treatment strategies in this region.
Published in the Journal Hepatology, the discovery of the new strains could inform hepatitis C treatment and vaccine development worldwide, and assist the World Health Organisation’s aim of eliminating hepatitis C globally.
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is transmitted mainly by needles and exposure to blood products. Infection can cause cirrhosis and liver cancer, and nearly 400,000 people die from hepatitis C each year. Globally, an estimated 71 million people have chronic hepatitis C infection, 10 million of whom live in sub-Saharan Africa and there is no current vaccine.
One-third (32%) of people who contract hepatitis C virus (HCV) as a child will go on to develop cirrhosis at a median of 33 years post-infection, according to new research.
The study, highlighting the importance of testing and early intervention in young patients with HCV, helps clinicians quantify the means by which infection is occurring in children.
Investigators from Birmingham Women and Children’s Hospital and Nottingham University Hospital NHS Trust analyzed data from the HCV Research UK database, finding 1049 enrollees who were diagnosed with HCV as a child. They found that most of the patients had contracted the virus through the use of intravenous drugs (52%), and the next-largest category contracted the disease via blood products (24%). Another 11% contracted the virus through perinatal infection.
AASLD 2018: AASLD Presidential Poster of Distinction¹
Abstract: #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.
The study evaluated whether DAA therapy was cost-effective in people infected with chronic hepatitis C without cirrhosis. Prior interferon and/or ribavirin-treated patients were excluded from this retrospective study. Two patient groups were identified and evenly matched by patient characteristics—one group received DAA treatment, one group did not (control group). The treated patients received DAA treatment between 2013 and 2015. Both groups were followed for a maximum of 3 years, and their medical costs were estimated. The medical costs of the two groups were compared including expenses from HCV extrahepatic manifestations (EH). The most common EH’s included fatigue (13%), type 2 diabetes (11%), and heart disease (9%). There were 3,069 patients evaluated and 852 (28%) patients treated with DAAs.
The cost savings in the DAA-treated group was significantly lower on average ($6,379 per patient, per year). The savings were mainly from a reduction in costs attributed to the care and treatment of extrahepatic manifestations.
Conclusion: Starting DAA treatment within the first three years of diagnosis of HCV is associated with significant cost savings.
Editorial Comments: This is a well-conducted study that should prompt earlier treatment of people newly diagnosed with hepatitis C. I would hope that insurance companies would consider this when evaluating approval of treatment.
¹Recipient Posters of Distinction are considered to be particularly noteworthy and represent the top 10% of all accepted poster presentations
AASLD 2018: AASLD Presidential Poster of Distinction
Abstract: #583 Retreatment with SOF/VEL/VOX in Treatment-Experienced Patients with and without HIV: The Resolve Study – Emily Covert, et. al. By Alan Franciscus
Retreatment of people who have not achieved a cure with a direct-acting antiviral (DAA) therapy is uncommon but an important unmet need. Retreatment is even more important in people coinfected with HIV or hepatitis B (HBV) or in people who had prior poor medication adherence. Additionally, some providers may not want to re-treat these ‘difficult-to-treat’ patients. In the current study (RESOLVE), the authors’ re-treated patients with a combination of sofosbuvir/velpatasvir/voxilaprevir (Vosevi) for 12 weeks.
There were 77 people enrolled—most were male, black and genotype 1a, 17 patients were coinfected with HIV, and two patients were co-infected with HBV. The majority of the patients in the trial (89%) had failed prior treatment with ledipasvir/sofosbuvir (Harvoni), but all DAA therapies were represented in the study.
The cure rate was 91% (70 of 77 patients). Two patients had not reached their cure determination results by the study completion date; five people discontinued treatment.
The most common side effects were fatigue, headache, diarrhea, abdominal pain, and constipation.
Conclusion: In this ‘difficult’ treatment population, a cure rate of 91% was achieved.
Editorial Comments: In my opinion, this is one of the most important studies on HCV treatment to come out of The Liver Meeting. Retreatment of the people who did not achieve a cure with DAA therapy will continue to be a problem even if it is a minority of people. I would like to understand what can be done to help the people who discontinued treatment early. Perhaps we could have reached 100% if there were other adherence strategies put in place.
A population-based study of 1.7 million-plus individuals tested for hepatitis C virus (HCV) has found further evidence that reinfection rates are elevated in people who inject drugs (PWIDs), even after being successfully treated with direct-acting antiviral (DAA) therapy.
Led by Carmine Rossi, PhD, of UBC, investigators analyzed the clinical outcomes of HCV patients in Canada treated with DAAs between January 2014 and July 2017. Qualified patients had achieved sustained virologic response (SVR) and had been subjected to at least 1 subsequent HCV RNA test for reinfection. They defined reinfection as a single positive RNA test after reaching SVR.
AASLD 2018: AASLD FOUNDATION Abstract Award Recipient
Abstract: #148 Sustained Virologic Responses Reduces the Incidence of Extrahepatic Manifestations in Chronic Hepatitis C Infection – Carmine Ross, et. al., By Alan Franciscus
This study evaluated the effect of hepatitis C (HCV) treatment with interferon-based therapies on extrahepatic manifestations (diabetes, chronic kidney disease, stroke, heart disease, osteoporosis and mood disorders such as depression). The results compared patients cured and not cured. Included in the analysis were 10,566 HCV patients that were followed for up to 10 years. The overall cure rate in this interferon-based therapy was 57%. All extrahepatic manifestations (diabetes, chronic kidney disease, end-stage kidney disease, stroke, osteoporosis with fractures, and mood disorders) improved except heart disease.
Conclusion: Treatment and cure of HCV significantly reduced extrahepatic manifestations of HCV.
Editorial Comments: This was a retrospective study of people treated with interferon-based therapies. Still, since this is a large long-term study it provides valuable information that treatment and cure significantly reduce many extrahepatic manifestations of HCV.
Briefly… These three abstracts illustrate the benefits of successful HCV treatment. By Lucinda Porter, RN
Abstract: #766 Cure of Hepatitis C Virus Infection with Direct Acting Antiviral Drugs Improves Work Place Performance – Ciara Bosh, et al. This study demonstrated that successful HCV treatment had a beneficial effect on participants’ ability to be fully engaged in the work place, unhindered by illness. This improved capacity for effective functioning in the work place is expected to enhance job retention, increase pay, and promote career advancement.
Abstract: #1553 “If I Get Cured, My Whole Quality of Life Will Change:” an in-Depth Qualitative Analysis of Patients’ Anticipated Beneﬁts if Cured from Hepatitis C Viral (HCV) Infection – Donna M. Evon, et al. This study examined some of the hopes and expectations that 28 patients had about HCV treatment. In addition to improving liver health and life expectancy, they hoped that HCV cure would improve many areas of life functioning, especially emotional well-being.
Abstract: #1566 Risk of Cardiovascular Disease Events after HCV Treatment: Results from Erchives – Adeel Ajwad Butt, et al. This large study (32,575 subjects) found that HCV treatment is associated with a reduction in cardiovascular events, especially when direct acting antiviral regimens (vs. PEG/RBV) are used.