New and Noteworthy
High cure rates for people on opiate substitution therapy with Holkira Pak
A small, mid-stage clinical trial of participants on opioid substitution therapy (OST) who took Holkira Pak and ribavirin for 12 weeks had a cure rate of 97% reported researchers in the Journal of Hepatology.
OST is taken by people who have a dependence on opiate drugs, such as heroin or oxycodone. OST prevents opiate withdrawal symptoms and cravings.
All 38 participants had genotype 1 virus and had been on OST for at least six months. The OST involved either methadone or buprenorphine.
Holkira Pak is a combination of three direct-acting antivirals (DAAs). DAAs attack the ability of the Hep C virus to make copies of itself. Holkira Pak consists of:
- paritaprevir, a protease inhibitor, which is boosted with ritonavir
- ombitasvir, an NS5A inhibitor
- dasabuvir, an NS5B inhibitor
Paritaprevir/ritonavir and ombitasvir are co-formulated into one tablet. Dasabuvir is its own tablet.
The treatment was well tolerated. The most common side effects were nausea, fatigue and headache. Eight participants developed anemia, a known side effect of ribavirin.
No dose adjustments for the OST medications were necessary. (HIVandhepatitis.com, September 2015, in English)
Delaying Hep C treatment in people who inject drugs leads to advanced liver injury
The average time to developing severe liver injury (cirrhosis) ranges between 34 and 46 years, for people who inject drugs, if left untreated, reported researchers of a systematic review and meta-analysis in the International Journal of Drug Policy.
The researchers analyzed data from 21 reports on people with Hep C who use drugs in middle or upper income countries. From the data they calculated rates of liver disease progression. They estimated rates for two different scenarios: when liver injury progressed at a steady rate or when it progressed at a variable rate.
They calculated that it would take on average 26 years to develop F3 fibrosis and 34 years for a person with Hep C to develop cirrhosis if the rate of liver injury is constant.
If the rate of liver injury is variable, they calculated that it would take on average 38 years to develop F3 fibrosis and 46 years to develop cirrhosis.
According to the researchers, “delaying treatment with the new drug regimens until advanced fibrosis develops prolongs the period of infectiousness to perhaps thirty years. Scaling up of effective Hep C prevention and early engagement in care and treatment will facilitate the elimination Hep C as a source of serious disease in people who inject drugs. (Healio.com, October 2015, in English)
Study finds higher death rate among HIV, Hep C co-infected than HIV monoinfected
The death rate is higher among people who are co-infected with Hep C and HIV compared to people with only HIV, reported researchers at the 55th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
The researchers analyzed the medical records from 2004 to 2014 of 745 HIV-positive patients from a clinic in Tennessee, Alabama. About two-thirds were men, most (80%) were African American, 16% had a history of injection drug use, and 14% were homeless.
Just over three-quarters of participants were retained in care, 76% were prescribed HIV treatment, and 64% had an undetectable HIV viral load. Overall, 24% had Hep C and HIV co-infection. However, this rate rose to 54% among patients who died.
Shorter survival was associated with HIV/Hep C co-infection, fewer clinic visits, last HIV viral load detectable (>75 copies/mL), low CD4 count (<200 cells/mm3), and older age.
The researchers concluded that HCV co-infection plays a major role in survival of people with HIV—even more so than detectable HIV viral load. (HIVandhepatitis.com, October 2015, in English)