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Friday, August 18, 2017

Canada

Great news in Canada. Two new drug regimens have been approved:  Vosevi from Gilead is a pangenotypic for retreatment of those who have failed previous DAA therapy Gilead Receives Approval in Canada for VOSEVI™ (Sofosbuvir/Velpatasvir/Voxilaprevir) for Re-treatment of Certain Patients with Chronic Hepatitis C Virus (HCV) Infection. And MAVIRET from AbbVie is the first and only 8-week, pan-genotypic treatment for hepatitis C patients without cirrhosis and who are new to treatment. AbbVie’s MAVIRET™ Approved by Health Canada for the Treatment of Chronic Hepatitis C in All Major Genotypes.

Treatment

Yet another article on the relationship between DAAs and HCC has been published, this time in Medscape. How Do Direct-Acting Antivirals for Hepatitis C Affect the Risk for Hepatocellular Carcinoma?

Here are some of the key points:

  • The strongest risk for HCC development is advanced liver disease.
  • Robust data support a decreased incident (new, de novo) HCC rate in patients with HCV cirrhosis after SVR with DAA treatment.
  • Clinical research suggests that when individuals develop HCC after DAA therapy, tumors demonstrate a more aggressive phenotype, which appears to be an immunologic phenomenon.
  • Patients with active HCC show lower SVR rates.

And there is good news for seniors with HCV: Treatment of hepatitis C virus (HCV) with sofosbuvir-based direct acting antivirals (DAAs) was recently found as effective and well-tolerated in elderly patients as it was in younger patients in previous development trials. Direct-acting Antivirals Effective in Older Patients with Hepatitis C.

Complications

Did you know that steatosis is an independent risk factor for fibrosis in African-Americans with chronic HCV infection? A study recently published in Digestive Disease Science found that hypertension, older age, obesity, and HIV are risk factors and that steatosis is an independent risk factor for liver fibrosis in African-Americans with chronic hepatitis C. Steatosis: An Independent Risk Factor for Fibrosis in Chronic HCV.

Also in the news again was an article showing that patients with HCV infection have a higher risk for carotid atherosclerosis and cerebrocardiovascular events. How exactly HCV might be related to increased cardiovascular risk is unclear, but several possible mechanisms have been proposed. The authors stress that although liver disease and liver cirrhosis account for the bulk of HCV-related disease burden and deaths, it is becoming increasingly evident that HCV infection is a systemic disease with extrahepatic manifestations. Hepatitis C Virus Infection and Cardiovascular Disease Risk.