Blasting the Florida Department of Corrections’ “long and sordid history of neglecting” inmates who have Hepatitis C infections, and citing a “risk of such deliberate indifference reoccurring in the future,” a federal judge ordered Thursday evening that the state must treat all inmates with the disease.
The order is the result of a class-action lawsuit begun by three Florida inmates nearly two years ago. According to the order, the truth uncovered at earlier hearings was “crystal:” that the Florida Department of Corrections did not treat inmates with this infection because the drugs used to cure it, called “direct-acting antivirals,” were too expensive.
In an order that “recast” his earlier findings into a permanent injunction, U.S. District Court Judge Mark Walker instructed the department to screen and treat all inmates for Hepatitis C. In his earlier preliminary injunction filed in late 2017, the department was required to treat prisoners by certain deadlines depending on the severity of the disease, but did not require treatment at the early stages.
CHICAGO — In this exclusive video from the International Liver Congress 2019, Marc Bulterys, MD, PhD, team leader of the Global Hepatitis Program at the World Health Organization in Geneva, Switzerland, discusses the prevention, care and treatment of hepatitis B and hepatitis C among children and adolescents.
“This is a group that we should not leave behind; we have to make sure that they also get access to care and treatment,” Bulterys told Healio Gastroenterology and Liver Disease.
According to Bulterys, the target of less than 1% of children becoming infected with hepatitis B was reached by 2017 ahead of the 2020 target. However, the prevalence remains around 2.3% in sub-Saharan Africa for hepatitis B.
VIENNA — In the face of the remaining gaps in the hepatitis C care cascade, timely screening, monitoring and linkage to care by general practitioners coupled with early treatment by specialists could effectively reduce the hepatic and extrahepatic burden of the virus, according to a real-world analysis presented at the International Liver Congress 2019.
“We recognize that with the advent of direct-acting antivirals, high cure rates are incredibly easy to accomplish, but they require us to close the gaps in the hepatitis C care cascade, otherwise we will not be anywhere near the ability to hit the WHO assigned targets,” Nancy S. Reau, MD, from the Rush University Medical Center in Chicago, said during her presentation.
Reau said that while we have clinical guidelines that clearly outline the “standard patient journey from screening to cure,” a 2014 meta-analysis found that there were significantly large gaps at each step of the care cascade including a diagnosis and awareness rate of only 50% and only 16% of patients receiving therapy.
An in-depth interview of veterans with hepatitis C virus (HCV) infection and their healthcare providers revealed reasons for declining or not adhering to direct-acting antiviral (DAA) treatment, despite its provision at little or no cost and the likelihood it would be curative.
Avy Skolnik, PhD, Center for Health Organization and Implementation Research (CHOIR), Edith Nourse Rogers VA Medical Center, Bedford, MA, and Hampshire College, Amherst, MA, and colleagues stressed the importance of recognizing attitudes toward HCV treatment in order to optimize outcomes for all patients with HCV, and particularly for veterans.
“This is especially true for veterans with HCV, who are over-represented in the population of individuals living with HCV and who are often contending with co-occurring substance use disorders, depression, anxiety, posttraumatic stress disorder (PTSD), homelessness, and other socio-economic challenges,” the investigators indicate.
In the United States, incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in older individuals. Chronic infection with hepatitis C virus (HCV) and hepatitis B virus (HBV) are important causes of HCC; however, the contribution of viral hepatitis to recent trends in HCC incidence among older Americans is unclear.
Data from the Surveillance, Epidemiology, and End Results-Medicare linkage (SEER-Medicare) for the years 2001 through 2013 were used to identify HCC cases among individuals aged ≥66 years and Medicare files were used to assess the HCV and HBV status of these HCC cases. Age-standardized incidence rates of HCV-attributable, HBV-attributable, and HCV/HBV-unrelated HCC were estimated overall and by age group, sex, and race/ethnicity. The authors also calculated annual percent changes (APCs) in HCC incidence.
Between 2001 and 2013, a total of 15,300 HCC cases occurred in this population. Overall HCC rates increased 43% from 16.3 to 23.3 per 100,000 population (APC, 3.40% per year), whereas HCV-attributable HCC rates nearly doubled from 4.2 to 8.2 per 100,000 population (APC, 5.62% per year). HCC rates increased more slowly for HBV-attributable HCC (1.3 to 1.8 per 100,000 population; APC, 3.17% per year) and HCV/HBV-unrelated HCC (11.3 to 14.1 per 100,000 population; APC, 2.35% per year). The percentage of HCC cases with evidence of HCV infection increased from 25.7% in 2001 through 2004 to 32.3% in 2011 through 2013, whereas the percentage with HBV remained stable at 8%. In 2013, higher rates for both HCV-attributable and HBV-attributable HCC were noted among individuals aged 66 to 75 years, men, and individuals of Asian ancestry.
Surveillance for hepatocellular carcinoma (HCC) — now ranking fourth among causes of cancer-related death worldwide and on the rise in the U.S. — needs improvement to boost survival rates, two researchers argued.
Despite some improvement in survival, the overall prognosis for HCC remains poor, according to Fashia Kanwal, MD, MSHS, of Baylor College of Medicine in Houston, and Amit G. Singal, MD, MS, of UT Southwestern Medical Center in Dallas, writing in Gastroenterology. They recommended closer adherence to surveillance recommendations as well as better biomarkers and other tools to detect HCC early in at-risk patients.
“The upward trend in HCC incidence underscores the importance of effective HCC surveillance strategies in the U.S., particularly among emerging at-risk cohorts such as those with NAFLD [non-alcoholic fatty liver disease] and post-SVR [sustained viral response] hepatitis C virus [HCV] cirrhosis,” the authors wrote.
VIENNA — Patients with hepatitis C genotype 3 and compensated cirrhosis had higher rates of sustained virologic response after treatment with Epclusa and ribavirin than with Epclusa alone or combined Sovaldi and Daklinza with ribavirin.
Kate Drysdale, MBBCh, from the Queen Mary University of London in the United Kingdom, presented data gathered from a national registry of patients with hepatitis C in England. According to Drysdale, HCV treatment within this registry is dictated by local prioritization and the lowest cost of acquisition determines choice of direct-acting antivirals.
Drysdale and colleagues analyzed registry data on 37,693 patients with HCV. Of the 14,603 adult patients treated with DAAs with a per protocol 12-week outcome, 13,959 achieved sustained virologic response for an overall SVR rate of 95.59%.
Donor organs are hard to come by partially because of ischemic damage, physical damage, presence of infection, and other reasons. Researcher at the University of Toronto in Canada and University of São Paulo in Brazil have developed a method of getting rid of bacteria and viruses from donor organs using only light.
The technique involves first removing all donor blood from the organ, running a preservation liquid through the organ, and illuminating organs using ultraviolet and red light for about a half hour or so. In order to boost effectiveness, a photosensitizing drug is introduced into the liquid that is activated by the red light, which in turn oxidizes any pathogens nearby. The perfusion aspect is already a standard of care, but it can’t completely get rid of all pathogens, so the light and photosensitizing drug finish off anything left over.
The new technique was tried by transplanting a lung from a donor pig that was infected with hepatitis C into another pig. The lung received light therapy during normothermic ex vivo lung perfusion, and the recipient pig went on to fare quite well and avoided becoming infected with hep C.