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Hep C Update

New Canadian Guideline Recommends Boomers Get Tested for Hep C

June 4th, 2018 at 10:22 am

A key recommendation in a new Canadian guideline on managing chronic hepatitis C virus (HCV) is to screen all people born between 1945 and 1975 for the disease, a departure from previous guidelines. The guideline, which contains comprehensive recommendations for diagnosing and managing the disease in diverse patient populations, is published in CMAJ (Canadian Medical Association Journal).

“The treatment recommendations in this guideline update are markedly changed from the previous Canadian Association for the Study of the Liver treatment  because of multiple advances in the field since their publication,” write Drs. Jordan Feld and Hemant Shah, Toronto Centre for Liver Disease and University Health Network, Toronto, Ontario, with coauthors.

Chronic HCV is a major public health problem in Canada with serious health effects leading to premature death. In 2013, about 252 000 Canadians were infected with HCV. People born between 1945 and 1975 have the highest rates of HCV, although an estimated 70% of this group have not been tested.

The guideline, created by the Canadian Association for the Study of the Liver, is aimed at physicians and other  care professionals to help them manage adult patients with chronic HCV infection. “Simplification of treatment regimens and better tolerability allows for expansion of the treater pool to primary care providers in Canada,” notes Hemant Shah. The guideline also contains quick-reference boxes and tables that describe who to test, suggested pre-HCV treatment workup, a list of Health Canada-approved direct-acting antivirals and recommended regimens for patients.

It differs significantly from a recent guideline from the Canadian Task Force on Preventive Health Care published in April 2017, which recommended against screening people who are not at high-risk of infection. However, the guideline is broadly consistent with those from other societies in Europe and the United States.

The authors recommend birth cohort screening for people born between 1945 and 1975 based on high rates of HCV in this group, evidence showing cost-effectiveness of detection and recent lower prices for HCV therapy in Canada that make treating HCV less expensive than in the past. In most provinces and territories in Canada, every infected person can now access therapy for Hepatitis C.

“We advocate for screening this baby boomer cohort because HCV prevalence is highest in this age group (1.55%), accounting for an estimated 63% of all HCV infections in Canada. Between 45% and 70% of Canadians infected with HCV are unaware they have the disease, which can lead to liver disease and death. It seems evident that the current policy of screening based on risk factors has not worked,” say the authors.

In a related commentary, Drs. Jawad Ahmad and James Crismale, Icahn School of Medicine at Mount Sinai, New York, New York, write “The updated Canadian Association for the Study of the Liver guideline takes an important step in continuing the fight against HCV in Canada, expanding screening indications to the baby boomer cohort and recommending curative therapy to all individuals affected by HCV.”

Hep C: An Important Canadian Story

August 14th, 2017 at 2:10 pm

Hepatitis C is a silent killer (people can have it for decades without any symptoms) and a story that is not commonly known in Canada. Yet this virus affects many people, highlights inequities in our health and social systems and is part of an important Canadian story.

Canada has a history of being on the forefront of addressing hepatitis C, starting with Dr. Michael Houghton, an internationally recognized microbiologist at the University of Alberta, who was the first to co-discover hepatitis C and continues to work with his team to create a vaccine for the virus.

Hepatitis C incidence is highest amongst the most marginalized and vulnerable Canadians: people who use injection drugs, Indigenous peoples and people in prisons.

Despite Canada’s significant role in discovering the virus, the sad fact is that more than half of Canadians who have hepatitis C do not know that they have it, and even less people have access to the lifesaving medications, which are now more widely available. Approximately 330,000 Canadians are estimated to have hepatitis C, but limited awareness and narrow testing guidelines have meant that most Canadians do not get tested for hepatitis C, even though they may benefit from treatment.

In addition to limited testing, the curious and maddening fact is that most Canadians with hepatitis C need to get more sick from the virus before they can access the treatments. Liver injury (called fibrosis) gets worse the longer a patient has hep C, and historically access to treatment was limited to those with particularly severe fibrosis because of the high cost of the medications. This situation is, thankfully, improving somewhat.

Last February, the pan-Canadian Pharmaceutical Alliance negotiated an agreement with several pharmaceutical companies to lower prices for six hepatitis C medications, which will make it easier for those with hep C to qualify for drug access. A number of provinces have announced changes in their provincial criteria and access is improving. In some provinces, however, access to medications is still somewhat restricted.

The story of hepatitis C also highlights broader social inequities and gaps in our health-care system. Hepatitis C incidence is highest amongst the most marginalized and vulnerable Canadians: people who use injection drugs, Indigenous peoples and people in prisons. Thirty-five per cent of the infections in Canada are among newcomers who come from high prevalence countries and have been exposed to hep C through the medical system. Yet these populations face the biggest barriers in accessing health-care services.

Prevention methods also remain somewhat inaccessible to populations who need them the most. In Canada, hepatitis C is primarily spread through injection drug use and the best way to prevent the spread of the virus is to provide new needles and comprehensive harm reduction programming to individuals who inject drugs. Needle and syringe programs have proven effective at reducing transmission, yet such programs are not available in prisons, where the prevalence of hepatitis C and of drugs use is extremely high. Needle and syringe programs are also very limited in rural and remote areas, as well as on reserves.

Canada could be poised to become a leader in its global response to hepatitis C. Last year, Canada endorsed the World Health Organization’s Global Health Sector Strategy on Viral Hepatitis, 2016-2021, committing us to the goals of eliminating viral hepatitis as a public health threat by 2030 and, specifically, to achieving a domestic diagnoses rate of 90 per cent, with 80 per cent of people living with hepatitis C being treated by 2030.

Hepatitis C could be — should be — a proud Canadian success story, building on the stellar work of Michael Houghton, our strong Canadian medical expertise, and the leadership coming from communities most impacted by hepatitis C. We need all Canadians to encourage our federal and provincial health departments to take action, ensuring medical access and health care for all.

Laurie Edmiston, executive director
CATIE, Canada’s source for HIV and hepatitis C information

Hep C: An Important Canadian Story

August 4th, 2017 at 12:10 pm

Hepatitis C is a silent killer (people can have it for decades without any symptoms) and a story that is not commonly known in Canada. Yet this virus affects many people, highlights inequities in our health and social systems and is part of an important Canadian story.

Canada has a history of being on the forefront of addressing hepatitis C, starting with Dr. Michael Houghton, an internationally recognized microbiologist at the University of Alberta, who was the first to co-discover hepatitis C and continues to work with his team to create a vaccine for the virus.

Hepatitis C incidence is highest amongst the most marginalized and vulnerable Canadians: people who use injection drugs, Indigenous peoples and people in prisons.

Despite Canada’s significant role in discovering the virus, the sad fact is that more than half of Canadians who have hepatitis C do not know that they have it, and even less people have access to the lifesaving medications, which are now more widely available. Approximately 330,000 Canadians are estimated to have hepatitis C, but limited awareness and narrow testing guidelines have meant that most Canadians do not get tested for hepatitis C, even though they may benefit from treatment.

In addition to limited testing, the curious and maddening fact is that most Canadians with hepatitis C need to get more sick from the virus before they can access the treatments. Liver injury (called fibrosis) gets worse the longer a patient has hep C, and historically access to treatment was limited to those with particularly severe fibrosis because of the high cost of the medications. This situation is, thankfully, improving somewhat.

Last February, the pan-Canadian Pharmaceutical Alliance negotiated an agreement with several pharmaceutical companies to lower prices for six hepatitis C medications, which will make it easier for those with hep C to qualify for drug access. A number of provinces have announced changes in their provincial criteria and access is improving. In some provinces, however, access to medications is still somewhat restricted.

The story of hepatitis C also highlights broader social inequities and gaps in our health-care system. Hepatitis C incidence is highest amongst the most marginalized and vulnerable Canadians: people who use injection drugs, Indigenous peoples and people in prisons. Thirty-five per cent of the infections in Canada are among newcomers who come from high prevalence countries and have been exposed to hep C through the medical system. Yet these populations face the biggest barriers in accessing health-care services.

Prevention methods also remain somewhat inaccessible to populations who need them the most. In Canada, hepatitis C is primarily spread through injection drug use and the best way to prevent the spread of the virus is to provide new needles and comprehensive harm reduction programming to individuals who inject drugs. Needle and syringe programs have proven effective at reducing transmission, yet such programs are not available in prisons, where the prevalence of hepatitis C and of drugs use is extremely high. Needle and syringe programs are also very limited in rural and remote areas, as well as on reserves.

Canada could be poised to become a leader in its global response to hepatitis C. Last year, Canada endorsed the World Health Organization’s Global Health Sector Strategy on Viral Hepatitis, 2016-2021, committing us to the goals of eliminating viral hepatitis as a public health threat by 2030 and, specifically, to achieving a domestic diagnoses rate of 90 per cent, with 80 per cent of people living with hepatitis C being treated by 2030.

Hepatitis C could be — should be — a proud Canadian success story, building on the stellar work of Michael Houghton, our strong Canadian medical expertise, and the leadership coming from communities most impacted by hepatitis C. We need all Canadians to encourage our federal and provincial health departments to take action, ensuring medical access and health care for all.

Laurie Edmiston, executive director
CATIE, Canada’s source for HIV and hepatitis C information

Health Canada Warning: Direct-Acting Antivirals May Cause Hep B Reactivation

December 7th, 2016 at 1:51 pm

healthcanada

OTTAWA, Dec. 1, 2016 /CNW/ – A recent Health Canada safety review found that patients infected with both hepatitis B and hepatitis C viruses who are being treated for hepatitis C with direct-acting antivirals may experience a reactivation of their hepatitis B. Hepatitis B reactivation is the return of an active hepatitis B infection, which can lead to serious complications such as liver failure.

As a result, Health Canada is working with manufacturers to strengthen the prescribing information for these drugs with a new warning about this risk.

Direct-acting antivirals are prescription medicines used to treat and, in most cases, cure chronic hepatitis C virus infections in adults. Without treatment, chronic hepatitis C virus infections can lead to serious liver problems, including cirrhosis (liver scarring), liver cancer and death.

When Health Canada completed its safety review in October 2016 there were no Canadian cases of hepatitis B reactivation. However, 13 international cases were identified. In some cases, the symptoms reported were consistent with moderate to severe hepatitis B reactivation, with one case resulting in liver failure requiring a liver transplant.

Health Canada will continue to monitor and evaluate the risk of hepatitis B reactivation associated with the use of direct-acting antivirals. If new safety information is identified, Canadians will be updated, as required.

The direct-acting antivirals available in Canada are:

  • Daklinza (daclatasvir)
  • Epclusa (sofosbuvir, velpatasvir)
  • Galexos (simeprevir)
  • Harvoni (sofosbuvir, ledipasvir)
  • Holkira Pak (dasabuvir, paritaprevir, ombitasvir, ritonavir)
  • Sovaldi (sofosbuvir)
  • Sunvepra (asunaprevir)
  • Technivie (paritaprevir, ombitasvir, ritonavir)
  • Zepatier (grazoprevir, elbasvir)

 

What you should do:

  • Tell your health care professional if you currently have or have ever had hepatitis B, or if you have other liver problems (such as cirrhosis), before starting treatment with direct-acting antivirals.
  • Talk to your health care professional if you have questions or concerns about using direct-acting antivirals.
  • Do not stop taking direct-acting antivirals without talking to your health care professional.

Information for healthcare professionals:

  • Healthcare professionals should screen all patients for past or current hepatitis B infections before starting direct-acting antiviral therapy for hepatitis C.
  • Patients with past or current hepatitis B infections who are receiving direct-acting antiviral therapy should be monitored both during treatment and during post-treatment follow-up. Monitoring should include watching for clinical signs and reviewing laboratory findings related to hepatitis flare or hepatitis B reactivation.

Report health or safety concerns
To report a side effect to a health product to Health Canada:

  • Call toll-free at 1-866-234-2345
  • Visit Health Canada’s Web page on Adverse Reaction Reporting for information on how to report online, by mail or by fax.

Related links:

Stay connected with Health Canada and receive the latest advisories and product recalls using social media tools.

Également disponible en français

 

SOURCE Health Canada

Call to Action for Strategy to Eliminate Hep C

September 29th, 2016 at 12:03 pm

hepcpetition

To help raise political awareness for a strategy to eliminate hepatitis C Action Hepatitis Canada has started an official Parliamentary Petition. The petition requires 500 signatures. Members of Parliament will be presented with AHC’s request for a National Strategy in the House of Commons. To sign go to this link.