The Louisiana Department of Health is currently developing a “subscription style” payment plan with pharmaceutical manufacturers to provide state residents with access to hepatitis C treatment.
HCV Next spoke with the department’s chief of staff, Pete Croughan, MD, about the landscape of HCV in the state and the novel payment model designed to expand treatment despite the expensive cost of direct-acting antivirals.
“Hepatitis C is definitely an epidemic here, like it is in many places, and equally tied to the opioid epidemic due primarily to transmission through reuse of needles,” Croughan told HCV Next. “National data has shown that rates of acute infections tripled in the last 5 years. This corresponds with our own internal data on increased rates of infection.”
For patients infected with hepatitis C virus (HCV) and treated with ledipasvir and sofosbuvir with or without ribavirin, HCV RNA may still be detectable and quantifiable at end of treatment, although sustained virological response (SVR) rates are still high, according to results published in Liver International.
These results do not indicate a need to prolong treatment in patients with detectable and quantifiable HCV RNA.
The study included participants with HCV genotype 1 who were treated with ledipasvir/sofosbuvir with or without ribavirin for 8 to 24 weeks who had HCV RNA testing completed using either the Roche COBAS AmpliPrep/COBAS TaqMan or the Abbott RealTime HCV assay (n=471). The researchers defined HCV RNA as detectable if it was either above or below the lower limit of quantification for the respective assay.
“It is unclear whether there are differences between direct-acting antivirals (DAAs) for hepatitis C virus in risk of hepatocellular carcinoma (HCC) after antiviral therapy,” wrote the authors, led by Elijah J. Mun, MD, Department of Internal Medicine, University of Washington, Seattle, WA. “We aimed to compare different DAA regimens with respect to risk of de novo HCC following antiviral therapy.”
Certain studies have indicated that DAAs heighten the risk for HCC occurrence and recurrence as compared with HCC risk secondary to interferon-based therapy. Some of these studies, however, were low power, short, and lacked adjustment for confounders.
Study Aims and Results: The study analyzed records of 1,270 chronic hepatitis C (HCV) patients with biopsy-proven compensated cirrhosis from 2006 through 2012 at 35 centers in France. The patient records were divided into three groups:
Patients treated with direct-acting antiviral (DAA therapy and were cured (336 patients),
Patients were treated with interferon-based therapy and were cured (495 patients), and
Patients never received DAA therapy and who never had a cure following interferon treatment (439 patients).
The study participants were included in a liver cancer surveillance program with ultrasound exams every six months, and their clinical and biological data were collected.
The patient characteristics in the DAA group were older, had higher proportions of diabetes or portal hypertension (high blood pressure in the liver), and severely impaired liver function. These health markers are predictive of more severe liver disease progression that may lead to liver cancer.
The 3-year incidence of liver cancer was 5.9% in the DAA group, 3.1% in the interferon-cured group and 12.7% in the non-cure group. Importantly, the DAA group had the least amount of liver cancer screening compared to the other two groups.
Conclusions: The authors’ concluded that the slightly higher rates of liver cancer in the DAA group can be explained by the patient characteristics (older age, a higher proportion of diabetes or portal hypertension, and severely impaired liver function) and the lower cancer screening rate.
Editorial Comments: The findings in this study (treatment with DAAs in people with more severe disease) with outcomes of more liver cancer makes sense. However, more studies are needed that have similar patient populations are to confirm these findings.
IU McKinney Professor Robert Katz and Indianapolis attorney Mark Sniderman, ’06, have won an order from the United States District Court that says the Indiana Department of Corrections must provide inmates with recommended hepatitis C treatment. Chief Judge Jane Magnus-Stinson, ’83, wrote the order. A story about the case appeared in the Indiana Lawyer.
“The Court concludes that the undisputed evidence in this case establishes that Plaintiffs’ need for medical treatment is toward the high end of the range (of medical need), and Defendants’ deliberate refusal to provide that treatment constitutes a violation of the Eighth Amendment,” Judge Magnus-Stinson wrote.
“We are reviewing the court’s order carefully. Our clients hope to have access to this life-saving treatment soon,” Professor Katz and Sniderman said in a statement.
Presidential Spokesperson Bassam Rady stated on Wednesday that Egypt is preparing to launch the “largest medical campaign in the world” by October to detect and treat Hepatitis C for 42 to 50 million citizens, as reported by Al Watan.
The national campaign is part of President Abdel Fattah Al Sisi’s initiative announced earlier in February to free the country from the disease by 2020. It will take place from October 2018 until April 2019 in all of Egypt’s governorates, targeting people between the ages of 19-59.
The official spokesperson for the Ministry of Health Khaled Megahed stated that the campaign will target 17 governorates, including Cairo, Fayoum, Giza, Beni Suef, and Aswan, while the next stages will take place in the rest of Egypt.
DENVER – All of the 2,200 Colorado prisoners with chronic hepatitis C are expected to be treated for the infection and will no longer have to undergo drug and alcohol treatment before they are treated under a settlement finalized Wednesday between the ACLU of Colorado and the Colorado Department of Corrections.
The ACLU says that the DOC agreed to spend $41 million between now and June 2020 to help treat the prisoners. The DOC will spend $20.5 million for this fiscal year, which runs through June 2019 for the treatments.
After that, the DOC will have to request, and subsequently spend, another $20.5 million over the next fiscal year, which runs from July 2019 through June 2020, the ACLU said.
The neuropsychiatric symptoms associated with hepatitis C virus (HCV) infection are likely caused by the body’s response to the virus’ effects on brain function, according to a study recently published in the Journal of Viral Hepatitis. This neuro-inflammatory and systemic response is akin to that observed in patients with autoimmune diseases of the liver.
This study included 33 controls and 132 participants, 46 of whom had HCV, 22 who had hepatitis B virus (HBV), 27 who had autoimmune hepatitis (AIH), 29 who had primary biliary cholangitis(PBC), and 8 who had AIH and PBC. A thorough neuropsychological assessment was administered to 88 participants.
Among all groups, scores on fatigue, depression, and anxiety were significantly higher than scores for controls, while mental scores on the Short Form-36 were significantly lower. Participants with HCV showed more pronounced fatigue than those with HBV and lower SF-36 scores than those with HBV but not than those with PBC and AIH. Word-learning was poorer among AIH, PBC, and HCV groups (but not HBV) compared with controls.