HCV Treatment & Prevention

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users: 
Jason Grebely,  Gail V. Matthews,  Margaret Hellard,  David Shaw,  Ingrid van Beek, Kathy Petoumenos,  Maryam Alavi,  Barbara Yeung,  Paul S. Haber,  Andrew R. Lloyd, John M. Kaldor, and Gregory J. Dore for the ATAHC Study Group: J Hepatol . 2011 July ; 55(1): 76–85.

Adherence to HCV therapy impacts sustained virological response (SVR), but there are limited data on adherence, particularly among injecting drug users (IDUs). We assessed 80/80 adherence (≥ 80% of PEG-IFN doses, ≥ 80% treatment), on-treatment adherence and treatment completion in a study of treatment of recent HCV infection (ATAHC).

Assessment and Treatment of Hepatitis C VirusInfection Among People Who Inject Drugs in the Opioid Substitution Setting: ETHOS Study:
Maryam Alavi, Jason Grebely, Michelle Micallef Adrian J. Dunlop, Annie C. Balcomb, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, and Gregory J. Dore; on behalf of the Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) Study Group: CID 2013:57 (Suppl 2)

Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV
care among PWID with chronic HCV infection.

Barriers and facilitators for assessment and treatment of hepatitis C virus infection in the opioid substitution treatment setting/ insights from the ETHOS study – Treloar – 2013 –
Journal of Viral Hepatitis – Wiley Online Library

Provision of hepatitis C virus (HCV) assessment and treatment via opioid substitution treatment (OST) clinics has been posed as an effective means of engaging populations with high HCV prevalence. This study explores OST client and health professional reports concerning barriers and facilitators affecting the delivery and uptake of HCV care and treatment within OST settings.

Barriers to Care and Treatment for Patients with Chronic Viral Hepatitis in Europe: A Systematic Review; George V. Papatheodoridis, Emmanuel Tsochatzis, Svenja Hardtke and Heiner Wedemeyer; Liver International (2014)

Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe.

Curing Chronic Hepatitis C — The Arc of a Medical Triumph:
Raymond T. Chung, M.D., and Thomas F. Baumert, M.D.: The New England Journal of Medicine, April 24, 2014

It may now be possible to imagine the global eradication of HCV infection, but three major challenges remain. First, in the absence of effective screening programs, HCV infection is often diagnosed at a late stage (in high income countries) or seldom diagnosed at all (in low- or middle income countries). Second, the high cost of DAAs will preclude their use in most infected patients in low- or middle-income countries; in high-income countries, the need for payers to provide major resources for HCV treatment may lead to the selective use of DAAs for certain patient subgroups. Third, reinfection remains possible even after successful curative therapy.

Perspective on Drugs: Hepatitis C Treatment for Injecting Drug Users, EMCDDA 2013:  
emcdda.europa.eu/topics/ pods/hepatitis-c-treatment

This analysis draws attention to the high levels of HCV infection among injecting drug users, both as an urgent public health priority, and as a field that has recently seen major advances in medical interventions. If hepatitis C treatments for injecting drug users are to be effective, they will need to be embedded in and delivered as part of a comprehensive package of interventions.

Eradication of Hepatitis C Infection: The Importance of Targeting People Who Inject Drugs, Editorial Hepatology,
AASLD 2013

If HCV treatment can be delivered effectively to those at highest risk of onward transmission, significant reductions in future HCV cases are possible. The feasibility of disease eradication must be assessed on both scientific criteria (e.g., epidemiological susceptibility, effective and practical intervention available, and demonstrated feasibility of elimination) and political criteria (e.g., burden of disease, cost of intervention). With effective, curative treatment now available, HCV meets these criteria.

Factors Associated with Uptake, Adherence, and Efficacy of Hepatitis C Treatment in People who Inject Drugs:
A Literature Review; Mravčík et al. Patient Preference and Adherence 2013:7 1067-1075

Specific factors are associated with poorer treatment outcomes in PWID on the side of both the patient and the treatment system. However, given that PWID can achieve treatment adherence and sustained virologic response rates comparable with those in nondrug users, drug use per se should not be considered a criterion for exclusion from treatment. Further development of measures leading to higher uptake of treatment and adherence in PWID and appropriate adaptation of HCV treatment guidelines represent important tools in this regard.

Elimination of Hepatitis C Virus Infection Among People Who Inject Drugs Through Treatment as Prevention:
Feasibility and Future Requirements; Jason Grebely, Gail V. Matthews, Andrew R. Lloyd, and Gregory J. Dore; Clinical Infectious Diseases 2013;57(7):1014–20

HCV therapeutic development is advancing rapidly, with effective, simplified regimens available in the near future.  Mathematical modeling studies have suggested that modest increases in HCV treatment uptake could lead to substantial reductions in HCV prevalence.  This Viewpoint focuses on issues that are important to consider when discussing the feasibility and future requirements of HCV treatment as prevention among PWID.

Frontiers in the Treatment of Hepatitis C Virus Infection
Joseph Ahn, MD, MS, and Steven L. Flamm, MD Gastroenterology & Hepatology Volume 10, Issue 2 February 2014

This article reviews the current screening recommendations and standard of care for treatment of HCV infection and highlights specific agents in the pipeline that should change the landscape of how HCV infection is treated in the near future.

Guidelines for the Treatment of Hepatitis C Virus Infection in Injection Drug Users: Status Quo
Jens Reimer, Bernd Schulte, Xavier Castells, Ingo Schafer, Susanne Polywka, Dagmar Hedrich, Lucas Wiessing, Christian Haasen, Markus Backmund, and Michael Krausz; Clinical Infectious Diseases 2005; 40:S373–8

Treatment guidelines are considered to be an important tool in steering patients to medical treatment. This study was conducted to analyze guidelines for the treatment of HCV infection in IDUs in the EU countries as a component of treatment access.  Recommendations for the treatment of HCV infection in IDUs vary substantially, from lack of recommendations and outright treatment disapproval to recommendations for treatment under specified circumstances. Recent guidelines that apply qualified process procedures that include literature research tend to be more permissive. Qualified guideline processes in each EU country and subsequently renewed pan-European guidelines are needed.

Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors:
Magdalena Harris; Tim Rhodes: Harm Reduction Journal 2013, 10:7

Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population.  Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.

Effective Health Care Program: Interventions to Improve Adherence to HCV Treatment:
Comparative Effectiveness: Agency for Healthcare Research and Quality www.ahrq.org

This report assesses the comparative effectiveness of treatment adherence interventions for adults receiving antiviral therapy for chronic HCV infection

Hepatitis C Treatment Gap in Europe; 
Razawi H. HCV treatment rate in select European countries, 2004-2010. 48th International Liver Congress (EASL 2013), http://www.aidsmap.com/page/2663697/

This study compared treatment rates in 22 European countries using data supplied from a variety of sources including key opinion leaders and national surveys, as well as international databases on pharmaceutical sales. The rate of hepatitis C treatment within the viremic population differed enormously between some countries in northern and western Europe and most countries in southern and eastern Europe.

Impact of New HCV Treatments Worldwide;
Drs Wei Zhang and Hui-ying Rao Journal of Gastroenterology 2014; http://dx.doi.org/10.1053/j.gastro.2014.03.008

The rapid development of new antiviral drugs for hepatitis C (HCV) and the availability of interferon (IFN)-free and soon ribavirin-free treatment regimens of 12 weeks duration with sustained virologic response (SVR) rates of >90% has stimulated predictions that HCV will be eradicated. This commentary discusses the impact of these new treatments in different regions of the world and the barriers to HCV eradication.

Knowledge and Attitudes about Treatment for Hepatitis C Virus Infection and Barriers to Treatment among Current Injection Drug Users in Australia
Anna Doab, Carla Treloar, and Gregory J. Dore; Clinical Infectious Diseases 2005; 40:S313–20

Despite recent improvements in outcomes of treatment for infection with hepatitis C virus (HCV), very few current IDUs have access to treatment programs. We examined the natural history of and treatment knowledge about HCV infection and barriers and willingness to seek treatment for HCV infection.

Methadone Maintenance Patients’ Knowledge, Attitudes, Beliefs, and Experiences Concerning Treatment for Hepatitis C Virus Infection
Kelly M. Canfield, Emily Smyth, and Steven L. Batk; Substance Use & Misuse, 45:496–514 Copyright © 2010 Informa Healthcare USA, Inc.

This study assessed HCV knowledge, attitudes, beliefs, and experiences in HCV antibody positive MMT participants and assessed readiness to consider HCV treatment after a 30-min HCV disease treatment education session. The study offered immediate serological testing to confirm chronic HCV disease, and provided a direct link to HCV treatment in a single visit. This study also assessed the number
of participants who, after receiving HCV education, chose to enroll in a NIDA-funded controlled trial of on-site versus off-site HCV treatment.

New Hepatitis C Therapies: The Toolbox, Strategies, and Challenges;
Jean–Michel Pawlotsky; Gastroenterology 2014;146:1176–1192

Therapy for hepatitis C is undergoing a revolution. Several new drugs against the hepatitis C virus (HCV) have reached the market and many others, including direct-acting antivirals and host-targeted agents, are in phase II or III clinical development. All-oral, interferon-free combinations of drugs are expected to cure more than 90% of infections. A vast amount of data from clinical trials are presented regularly at international conferences or released to the press before peer-review, creating confusion in the viral hepatitis field. The goal of this review is to clarify the current stage of HCV therapy and drug development. This review describes the different classes of drugs and their mechanisms and properties, as well as treatment strategies in development, including those that are interferon-based and interferon-free.

Overcoming Barriers to Prevention, Care, and Treatment of Hepatitis C in Illicit Drug Users;
Brian R. Edlin,  Thomas F. Kresina,  Daniel B. Raymond,  Michael R. Carden,  Marc N. Gourevitch,  Josiah D. Rich,  Laura W. Cheever6, and  Victoria A. Cargill;  Clin Infect Dis. 2005 April 15; 40(Suppl 5): S276–S285.

Controlling the HCV epidemic, therefore, will require developing, testing, and implementing strategies for the prevention, care, and treatment of HCV that will be effective for IDUs. Substantial barriers to providing effective care and treatment for IDUs with HCV stem from characteristics of the disease, patients, providers, and the health care system. As a result, although a large proportion of IDUs with hepatitis C express willingness to get treatment, a disproportionately low number of IDUs have received antiviral therapy for HCV. Fortunately, clinicians undertaking HCV care can draw upon substantial research and clinical experience managing HCV among IDUs

Prevention of HCV in Women, International Conference on Women and Infectious Diseases, Emerging Infectious Diseases,
www.cdc.gov/eid, Vol. 10, No. 11, November 2004

The most common exposure associated with HCV infection is injection drug use. Other less commonly identified risk factors include sexual contact; transfusions before blood screening was implemented; and occupational, nosocomial, and perinatal exposures.

Staying Safe From Hepatitis C: Engaging With Multiple Priorities;
Magdalena Harris, Carla Treloar, and Lisa Maher; Qualitative Health Research XX(X) 1–12 © The Author(s) 2011; sagepub.com/journalsPermissions.nav

Staying Safe is an international, qualitative, social research project, the aim of which is to draw on the experiences of long term PWID to inform a new generation of HCV prevention strategies. The motivations and strategies that enabled participants to avoid risk situations, and which might have helped them to “stay safe,” appeared not to be directly related to harm-reduction messages or HCV avoidance. These included the ability and inclination to maintain social and structural resources, to mainly inject alone, to manage withdrawal, and to avoid injecting-related scars. These findings point to the multiple priorities that facilitate viral avoidance among PWID and the potential efficacy of nonspecific HCV harm-reduction interventions for HCV prevention.

Treatment as Prevention: The Breaking of Taboos is Required In the Fight Against Hepatitis C among People who Inject Drugs:
Philip Bruggmann, MD, 2013

Taking this into account, the model described in this study suggests that scaling up treatment uptake rates for people who inject drugs with the new direct-acting antivirals (DAA) has the potential to, over time, significantly reduce the prevalence of chronic hepatitis C in this so far heavily underserved population.  However, in order to increase treatment uptake rates in this major at-risk group requires drastic changes on several levels, and the breaking of some taboos.

Understanding Barriers to Hepatitis C Virus Care and Stigmatization From a Social Perspective
Carla Treloar, Jake Rance, and Markus Backmund; Clinical Infectious Disease 2013

A large body of literature emphasizes the relationship between stigma and adverse health outcomes and health access measures. For people living with hepatitis C virus (HCV), stigma is a defining feature given the association of HCV with the socially demonized practice of injection drug use. However, there is little literature that specifically examines stigma as a barrier to HCV care and treatment. This review argues that the relationship between the person living with HCV and their health worker can work to ameliorate the effects of stigma.

Uptake of Hepatitis C Treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999–2011:
J. Iversen, J. Grebely, L. Topp, H. Wand, G. Dore and L. Maher: Journal of Viral Hepatitis, 2014,

This study examined trends in HCV treatment uptake among a large national sample of PWID attending Australian Needle and Syringe Programs between 1999 and 2011