By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Use of sofosbuvir-velpatasvir to treat hepatitis C virus (HCV) infection in injection drug users usually leads to a sustained virologic response at 12 weeks, according to an industry-supported study in the Lancet Gastroenterology & Hepatology.
Some 103 patients with chronic HCV infection (types 1–4) who reported injection drug use in the prior 6 months received sofosbuvir-velpatasvir once daily for 12 weeks. At baseline, three-quarters had injected drugs in the past month. Roughly 60% of participants were receiving opioid substitution therapy during the study.
Of 100 participants who completed treatment, 99 had an end-of-treatment response. The primary outcome — sustained virologic response 12 weeks later — occurred in 94% of all participants. Of the three participants who completed treatment but didn’t achieve the primary outcome, two were lost to follow-up and one had HCV reinfection.
Commentators note that although guidelines recommend HCV treatment for drug users, “stigma … has resulted in insurance restrictions and reluctance from providers to offer appropriate medical therapy.” They conclude that HCV-infected injection drug users “can and should be treated with direct-acting antivirals.”
Follow-up of this cohort is ongoing.
by Kenneth Bender
A best practice advisory (BPA) displayed in the electronic health record (EHR) of baby boomer patients in a multi-site healthcare system prompted a 5-fold increase of screening for hepatitis C virus (HCV) in the population that, according to the Centers for Disease Control and Prevention (CDC), has a 5-fold higher prevalence of HCV than other age groups.
Low screening rates for baby boomers in clinical practice have been noted in multiple studies, in spite of the CDC’s and US Preventive Services Task Force’s recommendation years ago, Monica Konerman, MD, Gastroenterologist and Clinical Lecturer, University of Michigan Hospitals and Health Centers, Ann Arbor, MI, told MD Magazine.
The Department of Health Care Policy and Financing has proposed new criteria for hepatitis C (HCV) treatment to take effect January 1, 2018. Under the new criteria, Colorado Medicaid will no longer require patients with HCV to have a fibrosis score of F2 or higher before being approved for treatment. Patients with fibrosis scores of F0 and F1, indicating no or minimal liver scarring or inflammation, would now be approved for HCV treatment through Medicaid.
The new criteria also states that re-treatment of HCV for patients for whom treatment previously failed “will be reviewed on a case-by-case basis.” Previously, the state Medicaid program would only approve a once-per-lifetime treatment using direct acting antivirals to treat HCV.
The criteria still requires that patients who abuse or misuse alcohol or controlled substances be in substance use counseling or treatment for 1 month prior to starting treatment. Maintaining this requirement goes against the recommendations of the Drug Utilization Review Board which recommended in November dropping the 1 month minimum and replacing it with enrollment in substance use treatment for any length of time.
Retaining this treatment restriction for people who use controlled substances will unfortunately prevent many of the individuals who are most likely to transmit HCV to others from being cured.
The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) launched the Hepatitis C: The State of Medicaid Access project.
This project includes a report that details hepatitis C treatment access restrictions in Medicaid programs in all states, the District of Columbia and Puerto Rico, including traditional fee-for-service as well as managed care. The report focuses on three of the most significant restrictions to treatment: liver damage, sobriety, and prescriber limitations. It is the most comprehensive public listing of these restrictions to date.
NVHR also issued report cards for each state Medicaid program. These report cards grade each state based on its restrictions and include recommendations for improving access to hepatitis C treatment. Colorado received a C+.
These materials are available for download at www.stateofhepc.org. The website also has a petition for advocates to sign calling for open access and will have media articles, resources and other materials.
The Colorado Department of Public Health and the Environment released their 2016 Viral Hepatitis Surveillance Report.
The report documents increases in hepatitis B and hepatitis C cases in Colorado. New cases of hepatitis C were especially pronounced among young people who inject drugs. From 2012-2016, more than half of all reported acute hepatitis C cases in Colorado were among people who inject drugs.
The National Alliance of State and Territorial AIDS Directors (NASTAD) recently released an important report exploring the discriminatory, biased, and unnecessary practice of requiring a period of sobriety prior to receiving hepatitis C (HCV) curative treatment.
Among people who inject drugs (PWID), the prevalence of HCV is a staggering 70% and while clinical recommendations suggest that everyone diagnosed should receive curative treatment, only a fraction of these individuals are currently eligible due to onerous and discriminatory sobriety restrictions. To achieve our goal of ending the HCV epidemic, stop the spread of the disease, and improve community health outcomes, we must reverse these devastating policies.
- People who use drugs can adhere to treatment
- Risk of re-infection among PWID is minimal
- Offering HCV curative treatment reduces the amount of transmissible disease within communities most affected
- Treatment of HCV among PWID is cost-effective and demonstrates the need for accessible, equitable insurance for all
VIEW THE NASTAD REPORT HERE
Darcy is the new Colorado HIV and AIDS Prevention Project (CHAPP) coordinator for LHC. As CHAPP coordinator, she works with patients at the addiction treatment center Crossroads Turning Points in Pueblo where she provides sex education and harm reduction workshops and performs free HIV and Hepatitis C testing. We are very pleased to have her working with us on this exciting project!
We’ll let Darcy introduce herself:
I come to the Liver Health Connection from a reproductive justice background. After relocating to Denver from Nebraska 7 years ago, I quickly became involved in the social justice community. I took a four year turn as a co-organizer for an annual event to combat sexual assault stigma and victim blaming. From there, I started my formal career at Planned Parenthood of the Rocky Mountains. I wore several different hats at PPRM, most notably opening their field organizing office for a grant funded project in Santa Fe, New Mexico for a year. After my yearlong sabbatical, I returned to Denver and started working in PPRM health centers as a medical assistant but soon chose to return to a focus on sexual health education. I am so thrilled to be working as the CHAPP coordinator at LHC!
When not wearing my sex educator/HIV prevention/program coordinator hat, I enjoy living life to its fullest in central Denver with my spouse, our two cats, and the world’s most adorable dog. My spouse, Jack, keeps us rolling in good literature as an IT specialist at the Tattered Cover bookstore. When we’re not reading or watching Parks and Rec on Netflix, we commit our time to volunteer advocacy work with Planned Parenthood and various other GLBTQ and social justice non-profit organizations. Like all good Coloradans, we also look forward to escaping to the mountains for hiking and camping whenever we get the chance! Autumn hiking near Kenosha to see the Aspens change is my favorite! Random talents include baking gourmet cheesecakes, which you can learn for yourself by bidding on my cheesecake tutorial package for Future: Perfect!