Diversity in HCV: 10 reports on HCV outcomes by demographic

Although hepatitis C cure rates continue to increase in the direct-acting antiviral era, especially in developed nations, some individuals still fail to achieve sustained virologic responses and others may have more risk factors for infection or transmission.

Recent studies have focused on defining risk factors based on observable demographic features, such as age, ethnicity and lifestyle. The following reports include results showing that African-American patients face lower SVR rates, women who inject drugs are at a higher risk for infection, HCV rates among men who have sex with men remain steady, and HCV prevalence is significantly lower in Iran compared with other Middle Eastern countries.

African-American HCV patients face significantly lower SVR rates

African-American patients were significantly less likely to achieve sustained virologic response after hepatitis C treatment with direct-acting antivirals compared with white patients, according to recently published data.

“Historically, race has played a major role in chronic hepatitis C rates and treatment responses with African-Americans being disproportionately affected,” Jihane N. Benhammou, MD, from the University of California Los Angeles, and colleagues wrote. “The disproportionate HCV infection rates in African-Americans and higher risk of developing HCC independently of fibrosis underscores the importance of understanding why these differences exist.” Read more

HCV hospitalizations increasing among baby boomers, men, drug users

Hospitalization for hepatitis C increased significantly between 2005 and 2014, especially among baby boomers, men, African-American and Hispanic patients, and patients with mental health and substance abuse disorders, according to data from a Healthcare Cost and Utilization Project statistical brief.

“Baby boomers are aging and I think that's where we're seeing the greatest increase in hospitalizations,” Quyen Ngo-Metzger, MD, MPH, from the Harvard School of Medicine, Massachusetts, and lead study author, told Healio Gastroenterology and Hepatology. “What’s really interesting, though, is that if you look at both the young age groups, say 18 to 50 years, and the older age groups, both of those age groups showed large numbers of comorbid diseases.” Read more

Asian patients achieve SVR with ravidasvir, ritonavir, danoprevir, ribavirin combo

Ravidasvir plus ritonavir-boosted danoprevir with ribavirin for 12 weeks resulted in 100% sustained virologic response among a cohort of Asian patients with hepatitis C genotype 1 without cirrhosis, according to recently published results of a phase 2 study.

“Many patients are intolerant or ineligible for interferon-based therapies. The efficacy of interferon-based therapies can be affected by factors such as cirrhosis status, HCV genotype (GT), IL28B genotype, etc.,” Jia-Horng Kao, MD, from the National Taiwan University College of Medicine and Hospital, and colleagues wrote. “All-oral, interferon-free regimens of direct-acting antivirals (DAAs) are better tolerated than interferon-based regimens with improved sustained virologic response (SVR) rates and shorter treatment duration.” Read more

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Inclusive criteria, generic drugs effective for HCV in limited resource nations

Researchers from the University of Cairo analyzed the rates of sustained virologic response among patients with hepatitis C in Egypt since the introduction of direct-acting antivirals to share data on the planning and prioritization of treatment in a nation with limited resources and high prevalence of HCV.

Prioritization based on fibrosis stage was not effective and enrollment for DAA therapy increased once the program included all stages of fibrosis. Additionally, the availability of generic drugs reduced costs and helped increased enrollment in the program. Read more

Focus on children with viral hepatitis imperative for elimination goals

Recent data revealed that, worldwide, 52 million children are living with viral hepatitis, compared with 2.1 million children with HIV or AIDS, according to data presented at the World Hepatitis Summit 2017 in São Paulo, Brazil.

“We must act and treat as many children as possible. The economic and social benefit of early hepatitis C treatment in children is substantial,” Manal El-Sayed, MD, professor of pediatrics at Ain Shams University, Cairo, Egypt, said in a related press release. “This includes avoiding disease progression, removing social stigma and improving activity and school performance, and reducing fatigue. However, the fundamental principle is to avoid transmission by adopting ‘cure as prevention’ at an early age and before high risk behaviors emerge that enable transmission.” Read more

Women with HCV face low ovarian reserve, infertility, miscarriage

Women of child-bearing age with hepatitis C showed early signs of menopause, putting them at greater risk for infertility, gestational diabetes and miscarriage, according to a recently published study. Sustained virologic response positively impacted these outcomes.

“We report that the relationship between HCV infection and reproductive status in women is much deeper and broader than previously thought, with profound consequences for reproductive function confirmed in cohorts from different countries,” the researchers wrote. “It remains to be assessed whether antiviral therapy at a very early age can positively influence the occurrence of miscarriages and to prevent ovarian senescence. ... The effect of treatment with new generation antiviral drugs could therefore be prospectively assessed with this dual purpose.” Read more

Women injecting drugs at higher risk for HCV than men

Women who inject drugs are about 39% more likely to become infected with hepatitis C virus than men who inject drugs, research suggests. A range of factors could account for the disparity, the researchers wrote in Clinical Infectious Diseases.

“Our findings provide important evidence that sex disparities in HCV acquisition exist independent of selected behavioral risk and demographic factors,” researcher Kimberly Page, PhD, MPH, division chief of the department of internal medicine at the University of New Mexico Health Sciences Center, and colleagues wrote. “When considering HCV risk differential among women, multiple factors including biological, social and network factors — as well as differential access to prevention services — need to be considered.” Read more

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No decline in HCV rates among HIV-positive men who have sex with men

Hepatitis C incidence among HIV-positive men who have sex with men has shown no significant decline in Europe, though the trends differ by geographical region and age, according to results of a recently published study.

“While HCV incidence appears to have stabilized in Western Europe and remained stable in Southern Europe, a recent increase in HCV incidence was observed in Northern Europe,” the researchers wrote. “Interestingly, higher HIV RNA levels, recent HIV infection and younger age were associated with higher HCV incidence. The time from HIV seroconversion to HCV infection has significantly shortened in recent years. Hence, routine and continued surveillance following HIV diagnosis is needed.” Read more

Rise of HCV among reproductive-age women suggests need for screening

A recent substantial increase in hepatitis C virus infection among reproduction-aged women in the United States highlights a need for routine HCV screening during pregnancy, according to recent data published in Annals Internal Medicine.

“The prevalence of HCV infection among pregnant women has been difficult to determine, because HCV screening is not performed routinely in this population but rather is risk based,” Kathleen N. Ly, MPH, from the Division of Viral Hepatitis at the CDC, and colleagues wrote. “As a result, many HCV infections may go undetected because of under-recognition of risk behaviors, as well as concerns about stigmatization or legal consequences if risk behaviors are disclosed.” Read more

HCV prevalence lower in Iran vs. other Middle Eastern countries

The seroprevalence of hepatitis C virus is lower in Iran compared with other countries in the Middle East, according to the results of a systematic review and meta-analysis. However, investigators found significant heterogeneity across studies, and thus concluded their evidence is limited.

“Our results demonstrate that the overall prevalence of HCV infection among [the] Iranian general population is relatively low compared to other developing countries,” they wrote. “However, the significant heterogeneity among included studies limits this conclusion. Therefore, further high-quality studies are recommended to provide more robust evidence on the prevalence of HCV among [the] general population.” Read more