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Friday, April 28, 2017

News Recap

Canada
New Canadian Testing Guidelines Released: On April 24, 2017, The Canadian Task Force on Preventative Health Care (CTFPHC) published its HCV Screening Guidelines in the CMAJ. The guidelines make the recommendation to continue screening those with known risk factors, but does not include a recommendation to screen the age cohort born between 1945-1975, which has been recommended by many of Canada’s top liver specialists and HCV advocates. You can read the letter from Action Hepatitis Canada, which includes a letter to the CMAJ from Dr. Jordan Feld here, the press release from the Canadian Liver Foundation, which includes comments from Dr. Morris Sherman here, and a commentary from Dr. Yoshida and others from the BCCDC here.

One of the arguments used by the task force to justify excluding boomers from testing is based on the premise that is it “unethical to screen for a disease when treatment is unavailable or unaffordable.”  However, as many specialists point out, the cost of treatment really has come down and access has been greatly increased. But the cost of treatment includes many other factors – such as screening, lab fees, and doctors fees. With this in mind, another article in this month’s CMAJ, commenting on the rejection of age-cohort hep C screening in Canada suggests ways of lowering cost of treatment further by including much broader use of Primary Care Practitioners (PCPs) in the treatment of HCV patients. HepCBC members advocate for far broader PCP treatment options and will continue to work with Canada’s top liver specialists, the Canadian Liver Foundation, Action Hepatitis Canada, and other groups to advocate for screening of all Canadians born between 1945 and 1975. A “Baby-Boomer” testing policy is evidence-based, economically and medically beneficial over the long term (unlike short-term thinking reflected in the new guidelines), stigma-free, and morally sound…THE RIGHT THING TO DO!

New Documentary: To launch National Aboriginal Hepatitis C Month in May, the Canadian Aboriginal AIDS Network (CAAN) is proud to release, Promising Practices in Timiskaming First Nation, the second film in a series of documentaries which showcase community-led initiatives and the power of storytelling to improve health outcomes Hepatitis C documentary sheds light on best practices.

ILC 2017

Liver Cancer:
Last week we reported the results of a meta-analysis reported at the 2017 International Liver Congress (ILC), patients were at no elevated risk of developing hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) following treatment with direct-acting antiviral therapy (DAA) for hepatitis C compared to interferon therapy Hepatitis C Patients at No Elevated Risk of Developing HCC Following DAA Compared to Interferon.

However since then updated results presented by Spanish researchers raised a red flag regarding observations of unexpected higher rates of hepatocellular carcinoma (HCC) recurrence following treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection. “These data indicate that there needs to be further research conducted in this area, clarifying the mechanism for the association between liver cancer recurrence and DAA therapy. Our study offers further support to previous findings that there is an unexpected high recurrence rate of hepatocellular carcinoma associated with DAAs, and that this association may result in a more aggressive pattern of recurrence and faster tumour progression.”  One possible explanation is that DAA treatment can be tolerated by patients with more advanced HCV disease and HCC recurrence following DAA is unrelated to the treatment, but is an expression of disease progression in patients that were at high risk prior at baseline. Higher Risk of HCC Recurrence Observed Following DAA Therapy for Hepatitis C.

8-Week Treatment for Genotype 3?:
Results presented at ILC 2017 showed 95% of genotype 3 patients on its pan-genotypic regimen of glecaprevir+pibrentasvir were free of disease, 12 weeks after completing an eight-week treatment course. The Daklinza and Sovaldi combination is the current standard of care for genotype 3 hepatitis, but AbbVie is attempting to produce a more patient-friendly alternative with a shorter regimen.  This follows the general pattern of hep C treatments in recent years, where manufacturers produced cures with more manageable side effects and increasingly short treatment durations. Genotype 3 is the second most common form of the disease and is more difficult to treat, with Gilead’s newest combination, Epclusa (sofosbuvir+velpatasvir), requiring a 12-week treatment course. AbbVie takes aim at Gilead and BMS with 8-week hep C treatment.