World Hepatitis Day: Screening, testing key to elimination

“Eliminate Hepatitis” is this year’s World Hepatitis Day theme. As a part of WHO’s Global Strategy on Viral Hepatitis, which includes the goal of eliminating hepatitis C and hepatitis B, World Hepatitis Day is designed to promote awareness of hepatitis infection, related risks and treatment options.

“Very few people know that they have hepatitis, and very few people have been tested. So what is really important is that we scale up access to testing, which would allow us to scale up access to treatment,” Gottfried Hirnschall, MD, MPH, director of the department of HIV and the Global Hepatitis Program at WHO, said during a press conference. “We can estimate that, globally speaking, less than one person in 10 knows their status and therefore fewer than that will be on treatment.”

During the press conference, Hirnschall and colleagues presented initial data from an ongoing survey conducted in collaboration with Glasgow Caledonian University and the World Hepatitis Alliance. WHO sent questionnaires to 116 countries. Of those, 28 represented approximately 70% of the global hepatitis burden. Survey data showed most of those high-burden countries have established national hepatitis elimination committees with national plans and targets in place and many have dedicated funding for national health insurance programs for hepatitis treatment. However, the high-burden countries still face major challenges in setting up surveillance systems, training their health work force, scaling up care, and mobilizing funds.

Today, Healio.com/Hepatology showcases recent reports on hepatitis screening innovation and challenges, high-risk groups, and recent treatment successes.

Facing the Challenges of Universal Screening for HCV

By most objective measures, implementing universal screening in baby boomers has been suboptimal. In the estimation of many experts, it has been a failure. This failure is frustrating because the end zone — eradication of HCV altogether — feels tangible in the DAA era. But despite the setbacks, talk of universal screening for HCV persists.

Vincent Lo Re, MD, MSCE, associate professor of Infectious Diseases in the Perelman School of Medicine at the University of Pennsylvania, provided a broad view. “Society would benefit from any measure that sheds light on the subclinical burden of chronic HCV infection,” he said. “Earlier detection of chronic HCV could allow earlier treatment of chronic HCV and cure, which would reduce rates of liver complications such as decompensated cirrhosis and hepatocellular carcinoma, decrease extra-hepatic complications, and help to reduce HCV transmission and incidence of infection.” Read more

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New EHR alert increases HCV screening among baby boomers

Implementation of an electronic health record-based prompt significantly increased hepatitis C screening rates among baby boomers in primary care. According to the researchers, HCV screening among adults born between 1945 and 1965 increased fivefold during a 1-year period following implementation of the Best Practice Advisory (BPA) EHR alert.

“Although there has been dramatic advances in therapy, there remain significant barriers to HCV elimination including deficiencies in screening and subsequent linkage to care,” Monica A. Konerman, MD, MSc, from the University of Michigan, told Healio.com/Hepatology. “Despite evidence-based recommendations, uptake of one-time universal HCV screening among baby boomers remains low. Various approaches have been evaluated to optimize screening rates, but most fall short in their ability to confirm diagnosis and plug patients into specialty care. Primary care providers (PCPs) are uniquely positioned to have a high impact from HCV screening as continuity of care with patients facilitates follow-up throughout the HCV care cascade.” Read more

Urban clinic achieves high SVR rates in HCV/HIV coinfected patients

Patients with hepatitis C and HIV coinfection had high rates of sustained virologic response in an urban clinical setting with the use of standard nurse and pharmacist adherence support programs, according to results of a recent study.

“In this real-world cohort of predominantly black, inner city HIV/HCV coinfected patients, treated with oral [direct-acting antivirals], we observed high SVR rates (above 95%),” the researchers wrote. “Despite the high prevalence of psychiatric disease and addiction disorders, the observed SVR rate was similar to that observed in registration clinical trials. These HCV cure rates were consistently high regardless of race, cirrhosis status and HCV treatment experience.” Read more

HCV rates climbing in younger HIV-positive MSM

Hepatitis C infection rates continue to increase in Northern Europe in recent years among younger men who have HIV and have sex with men, with those more recently infected with HIV showing higher rates of HCV infection, according to a recently published article.

“No decline in HCV incidence was observed in recent years, although trends seem to differ by geographical region,” the researchers wrote. “HCV screening among HIV-positive MSM should be continued and routinely and frequently offered. Furthermore, targeted preventive measures should be implemented and/or scaled-up to decrease the risk of HCV acquisition.” Read more

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FDA approves Vosevi for HCV

FDA announced the approval of Vosevi for the treatment of adults with chronic hepatitis C genotypes 1 through 6, according to an agency press release.

“Direct-acting antiviral drugs prevent the virus from multiplying and often cure HCV. Vosevi provides a treatment option for some patients who were not successfully treated with other HCV drugs in the past,” Edward Cox, MD, director of the office of antimicrobial products in the FDA’s Center for Drug Evaluation Research. Read more

Triple therapy DAA leads to SVR after virologic relapse

The direct-acting antiviral combination of grazoprevir, ruzasvir and uprifosbuvir, with or without ribavirin, for either 16 or 24 weeks was safe and effective for patients with hepatitis C who had previously failed NS5A inhibitor-containing treatment, according to results of two phase 2 studies.

“People with hepatitis C virus (HCV) infection who have failed treatment with an all-oral, direct-acting antiviral (DAA) regimen represent a challenging treatment population. Re-treatment using the same regimen results in suboptimal efficacy; thus, these people have limited re-treatment options,” David Wyles, MD, from the University of Colorado School of Medicine, and colleagues wrote. “Current guidelines suggest deferral of treatment in anticipation of better re-treatment options for people with [genotype 1] infection without an urgent indication for re-treatment who have failed treatment with an NS5A inhibitor-containing regimen.” Read more

AbbVie receives CHMP positive opinion for Maviret for chronic HCV

AbbVie has received a positive opinion from the Committee for Medicinal Products for Human Use for its ribavirin-free regimen Maviret for the treatment of chronic hepatitis C of all genotypes, according to a press release.

“Maviret is the culmination of AbbVie’s efforts to provide one pan-genotypic regimen for as many patients living with HCV as possible,” Janet Hammond, vice president and therapeutic area head of virology, told Healio.com. “CHMP is an important milestone in our ongoing journey to bring our treatment to patients in Europe, and if approved, will provide an 8 week option for the majority of patients, as well as an additional option for specific patients who currently have limited options, like those with severe chronic kidney disease.” Read more