In this issue:
- CATIE News: Hepatitis C treatment program improves access to housing, income and healthcare
- HIV/Hep C co-infected people with moderate or severe liver injury at risk for liver-related death
- People co-infected with Hep C and HIV do less well after liver transplantation
CATIE News: Hepatitis C treatment program improves access to housing, income and healthcare
A community-based multidisciplinary team model for providing Hep C care improved access to housing, income supports and healthcare for participants, reported researchers in the International Journal of Drug Policy.
The main component of the Toronto Hep C Community Program (TCHCP) is a weekly two-hour support group that runs for 16 to 18 weeks. During the group time people receive and share information about Hep C and access medical appointments with doctors and nurses.
The evaluation was a prospective (participants were followed over time) study. Many of the 78 study participants were highly marginalized with the majority reporting using social assistance and having a history of incarceration. The majority also reported additional health issues, such as chronic illness or mental health issues.
At the beginning of the study, 54% of participants reported stable housing, and this increased to 76% by the end of the study, which was one year after the support group sessions.
Similarly, the number of participants receiving provincial government disability benefits increased from 55% at the beginning of the study to 75% at the end.
Prior to starting the program, only 15% had seen a Hep C specialist. After one year of follow up, 54% of participants had seen a specialist. Additionally, almost all participants (93%) also had a visit with the program’s HCV primary care doctor.
The study also measured the participants’ perception of their overall health. At the beginning of the study the majority of participants reported poor or fair overall health and this did not change by the end of the study.
“Our study shows that community-based, multidisciplinary, harm reduction models of Hep C care driven by peer engagement and group support can lead to improved access to Hep C treatment with benefits that extend beyond Hep C to key social determinants of health”, concluded the researchers. (catie.ca, July 2015, in English and French)
HIV/Hep C co-infected people with moderate or severe liver injury at risk for liver-related death
People co-infected with Hep C and HIV are more likely to die of liver-related causes if they have moderate to severe liver injury, and they should be prioritized for the new Hep C treatments, according to a study described in the journal AIDS.
The study, conducted as part of the EuroSIDA cohort, looked at outcomes among nearly 4000 cohort members with HIV and Hep C, aiming to provide guidance on who should be prioritized for treatment with new direct-acting antiviral (DAA) therapy.
A majority of participants (68%) were men, almost all were white, the median age was 37 years, and 70% had a history of injection drug use.
Liver injury or fibrosis was measured using the METAVIR scale where F0-F1 indicates no or mild liver injury, F2-F3 moderate liver injury and F4, severe liver injury or cirrhosis.
Liver-related deaths accounted for 145 (21.6%) of total deaths in the study population.
Having stage F4 liver injury (cirrhosis) was associated with a six times higher likelihood of liver-related death. While have stage F2 or F3 liver injury was associated with a 2.5 times higher likelihood of liver-related death.
At all fibrosis stages, the risk of liver-related death rose as CD4 counts fell.
“Treatment with DAAs should be prioritized for those with at least F2 fibrosis,” the study authors concluded. “Early initiation of combination ART [antiretroviral therapy] with the aim of avoiding low CD4 cell counts should be considered essential to decrease the risk of liver-related death and the need for Hep C treatment.” (HIVandhepatitis.com, July 2015, in English)
People co-infected with Hep C and HIV do less well after liver transplantation
People with Hep C and HIV co-infection were more likely to experience organ rejection after a liver transplant than people with only Hep C or HIV according to a review of 11 years of experience with liver transplantation in people with Hep C and HIV, reported researchers in Clinical Infectious Diseases.
The researchers reviewed all liver transplants that happened in the U.S. between 2002 and 2013. There were a total of 43, 987 liver transplants in people with HIV or Hep C or both.
This study population was broken down into the following groups of people:
- 20,829 with Hep C
- 72 with HIV
- 160 with both Hep C and HIV
- 22, 926 people without Hep C or HIV, which served as the reference group
The one and three-year likelihood of survival was lowest in the co-infected group (74% and 47%, respectively) compared to the reference group (89% and 76%). In the group of people with Hep C and the group of people with HIV the one-year likelihood of survival was similar to the reference group but the three-year likelihood of survival was lower (66% and 67%).
Organ rejection and graft loss was significantly more common in the co-infected group (44.8%) compared to the reference group (23.6%).
Having only HIV was not significantly associated with an increased risk of death or organ rejection whereas having only Hep C or Hep C/HIV co-infection was.
The authors concluded that “any excess post-transplant risk for HIV/Hep C co-infected people is related to hepatitis C, underling the importance of treating this infection.” (HIVandhepatitis.com, June 2015, in English)