GPs across Western Australia will receive a new chronic hepatitis B
and C primary care pathway later this month. WA Health has developed
the pathway to assist GPs and primary health care providers assess and
manage patients with hepatitis B or hepatitis C in the community.
Across Australia, only a small proportion of those living with
chronic hepatitis B or C are accessing treatment. Treatment with
antiviral medication can significantly reduce the risk of complications
such as cirrhosis and liver failure.
The clinical pathway has been developed in close collaboration
with key stakeholders, and contains up-to-date evidence-based
recommendations as well as links to a range of patient and health
It provides a quick guide for GPs and summarises:
what patients can do to optimise their own health
how to manage their long-term care
which patients to refer
how to refer
where to go for more information.
Thanks to all the clinicians, GPs, Communicable Disease Control
Directorate staff and non-government organisations that supported the
development of this resource.
Only about 60% of people with a positive hepatitis C antibody test received a follow-up RNA test during the period of 2003 to 2010, new data suggest.
“With curative pharmacotherapy potentially available now for most persons, application of reflex testing to HCV RNA following a positive HCV antibody test is critical to the prompt determination of HCV infection status,” investigators for the Chronic Hepatitis Cohort Study wrote in Clinical Infectious Diseases. “As efforts to expand the use of reflex testing are planned, in part through the clinical validation of quantitative assays, a reassessment of HCV RNA testing trends in the future will be useful to determine the degree to which reflex testing has been implemented.”
“Testing for HCV RNA after a positive test for HCV antibody is necessary
to determine the presence of current HCV infection and is imperative
for making clinical decisions involving treatment, to counsel those
infected to minimize additional hepatic injury and to prevent HCV
transmission,” the researchers wrote. “All persons whose HCV infection
status is unknown and who test positive for HCV antibody should promptly
undergo testing for HCV RNA.”
Low-dose oral interferon could be more effective than other
treatments for reducing the risk for hepatitis C virus relapse in
patients with mild liver fibrosis, according to a recent study.
In a double blind study, researchers analyzed 169 chronic HCV patients with genotype 1b who had been treated with pegylated interferon-alfa
and ribavirin. They were randomly assigned interferon-alfa lozenges at
500 IU per day (n=59), 1,500 IU per day (n=53) or placebo (n=57) for 24
The high price on one hand and the urgency to provide treatment for
chronic Hepatitis C Virus (HCV) infection on the other has become a
dilemma for healthcare professionals, hospital representatives,
insurers, and patient advocates including Medicaid as to how to go about
administering these medicines. This was the agenda at a recent meeting
for the California Technology Assessment Forum (CATF), a group
affiliated with health insurers conducting meetings in the wake of
advances made in treatment options. It was estimated that any line of
treatment carried on with these two drugs could cost as much as $66,000
to $84,000 in one course — an amount that would make the entire health
insurance system go bankrupt.
Finding a feasible solution to this issue was no less a challenge for
the 15 member panel who convened the meeting. It was agreed upon
however, that with the drug makers having defended their pricing, owing
to the efficacy and potential against chronic HCV, there is currently no
scope of a possible price reduction. According to Rena K. Fox, a
professor of medicine at the University of California, San Francisco,
“What I really wish for is that we could push back on the price, rather
than make patients wait. But since we don’t have the ability to change
the price, we have to decide which patients are the most urgent.” Hence,
in a country where almost 3 to 5 million people are diagnosed by HCV
every year, it became necessary to prioritize the needs of each patient
by assessing the severity of infection.
The question that hepatitis C patients ask me the most is, “Should I
go ahead and do treatment now with the new drugs, or should I wait for
interferon/ribavirin-free regimens?” My answer is that I cannot give
medical advice, and that you need to discuss this with your doctor.
However, I can give you some information that may help you as you make
A few months ago, two new hepatitis C treatments were approved by the FDA—Sovaldi and Olysio.
Sovaldi’s approval was especially momentous since it was the first
all-oral hepatitis C treatment to be approved, in this case for patients
who have genotype 2 or 3 or who can’t take interferon. Sovaldi has a
higher cure rate and shorter treatment length than Olysio. It also has a
higher price tag, but many insurance plans are covering the cost.
The University of Nebraska Medical Center is involved in an
international registry that’s evaluating new treatments for hepatitis C,
a disease that threatens many baby boomers.
a regional referral center for hepatitis C, is part of the Hepatitis C
Therapeutic Registry and Research Network, or HCV-TARGET. The network
will track thousands of patients over the next five years to monitor the
effectiveness and safety of new drugs to determine which ones are most
effective and can cure the disease most quickly with the fewest side
The network is made up of university and
community physicians at 103 sites in 31 states, Puerto Rico, Canada and
Europe, in partnership with the U.S. Food and Drug Administration.
Anyone being treated for the virus using newer medications is eligible to participate in the registry.
People with precirrhosis
and HIV/HCV coinfection run a high risk of liver decompensation,
according to results of an 892-person analysis in Spain. The researchers
believe precirrhosis patients with HIV/HCV should begin immediate
Liver decompensation is an advanced cirrhosis stage in which the liver
can no longer function normally. Understanding which patients with
cirrhosis run a high risk of decompensation is critical to prioritizing
therapy. A group of Spanish clinical investigators conducted this study
to determine risk of decompensation in HIV/HCV-coinfected patients with
Morbidity and mortality from co-morbid hepatitis C (HCV) infection in HIV co-infected
patients are increasing; hence, the management of hepatitis co-infection in HIV is
now one of the most important clinical challenges. Therefore, the development of direct
acting antivirals (DAAs) for treatment of HCV has been eagerly awaited to hopefully
improve HCV treatment outcome in co-infected individuals. Indeed, the availability
of the first HCV protease inhibitors (PI) boceprevir and telaprevir for HCV genotype
1 patients has changed the gold standard of treating hepatitis C allowing for substantially
improved HCV cure rates under triple HCV-PI/pegylated interferon/ribavirin therapy.
Moreover, numerous other new DAAs are currently being studied in co-infected patient
populations, also exploring shorter treatment durations and interferon-free treatment
approaches promising much easier and better tolerated treatment regimens in the near
future. Nevertheless, numerous challenges remain, including choice of patients to
treat, potential for drug-drug interactions and overlapping toxicities between HIV
and HCV therapy. The dramatically improved rates of HCV cure under new triple therapy,
however, warrant evaluation of these new treatment options for all co-infected patients.