New and Noteworthy
World Health Organization releases global guidelines for Hep C treatment
The World Health Organization (WHO) has released global guidelines for the screening, care and treatment of people with hepatitis C. The guidelines recommend:
- Sofosbuvir (Sovaldi) and ribavirin with genotype 1,2,3 or 4 virus, with or without peg-interferon, depending on the genotype, or;
- Simeprevir (Galexos) with peg-interferon and ribavirin for genotype 1 virus
The guidelines make a strong recommendation for testing everyone in a population with a high rate of hepatitis C and those with a previous risk of exposure to hepatitis C. Worldwide, the majority of people with hepatitis C live in Asia and Africa, where access to testing and treatment is limited.
Other recommendations in the guidelines include:
- Counselling to reduce alcohol intake for people with Hep C with moderate or high alcohol use
- Measures to assure the safety of medical procedures and injections in health care settings
- Harm reduction interventions for people who inject drugs
According to the WHO, the current pricing of hepatitis C medications makes them inaccessible for most middle- and low-income countries. A concerted effort is needed to reduce the price of Hep C medicines. (HIVandhepatitis.com, April 2014 in English)
CATIE News: Studies investigate the presence of hepatitis C virus among gay and bisexual men
During the past decade, a growing body of research has pointed to the sexual transmission of hepatitis C among HIV-positive gay and bisexual men. Researchers in four high-income countries, Sweden, Switzerland, the Netherlands and Australia, have been investigating the sexual transmission of hepatitis C among gay and bisexual men. Their findings suggest that among HIV-negative gay and bisexual men who do not use drugs or have high-risk sex, hepatitis C is rare. In the case of sexual transmission among HIV-positive gay and bisexual men, the Hep C virus is thought to be transmitted through blood-to-blood contact, not through hepatitis C in vaginal or rectal fluids.
Why are HIV-positive gay and bisexual men at risk?
A number of factors are believed to interact to create the conditions where hepatitis C can be sexually transmitted, including:
- Serosorting – when someone chooses to have condomless sex with partners of the same HIV status
- Trauma to mucosal surfaces –during rough anal sex damage can occur to the delicate tissue lining of the anus, penis and rectum
- Drug use and mucosal surfaces – some drugs such as crystal meth can dry mucous membranes, making them more likely to bleed
- HIV –HIV weakens the immune system, leading to an increase in Hep C virus in the blood and making transmission of the virus more likely
- Other sexual transmitted infections (STIs) –STIs such as herpes and syphilis can cause sores, ulcers or lesions that could act as entry points for the Hep C virus
There are many strategies available to prevent the sexual transmission of hepatitis C, such as:
- Using new condoms or gloves for each new partner
- Not sharing drug use equipment
- Having regular medical checkups
- Getting frequent testing for STIs and treatment if necessary
- Getting vaccinations for Hep A, Hep B and human papillomavirus
(catie.ca, April 2014, in English and French)
Sofosbuvir (Sovaldi) and simeprevir (Galexos) combination shows high cure rates for “hard-to-treat” participants
A mid-stage trial of 12 weeks of sofosbuvir (Sovaldi) and simeprevir (Galexos) with or without ribavirin resulted in a 93% cure rate among participants with genotype 1 virus and advanced liver damage or prior null response to treatment, reported researchers at the EASL International Liver Congress in London.
People with advanced liver damage or who have taken treatment before but didn’t respond (prior null responders) are considered hard-to-treat because they tend not to do well on interferon-based treatments.
Both groups were tested for 12 or 24 weeks but participants on the 12 week treatments did as well as those on the 24 week treatment.
The treatment was safe and generally well tolerated. Side effects included fatigue, headache and nausea.
Both sofosbuvir (Sovaldi) and simeprevir (Galexos) are approved for use in Canada but the official indications for the drugs do not include use of them together. Hep C treatment guidelines in the U.S. and Europe recommend this combination for people with genotype 1 or 4 virus who are unable or unwilling to take interferon treatment.
Further trials of sofosbuvir (Sovaldi) simeprevir (Galexos) will be tested for a shortened treatment of eight weeks. (HIVandhepatitis.com, April 2014, in English)