Below is a curated collection of recent literature and resources relevant to the national effort to address HCV and complex comorbidities within primary care.
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- Significant increase in risk of fibrosis or cirrhosis at time of HCV diagnosis for Hispanics with diabetes and obesity compared with other ethnic groups. Clin Gastroenterol Hepatol. 2019;17:1356-1363.
Researchers determine whether metabolic risk factors contribute to advanced liver diseases having higher prevalence in Hispanic patients at diagnosis of hepatitis C.
- Evaluation of a multifaceted intervention to reduce health disparities in hepatitis C screening: a pre-post analysis. Hepatology. 2019;70:40-50.
Researchers examined the effectiveness of a multifaceted intervention to improve HCV screening in a large safety net health system.
- Cost-effectiveness of hepatitis C screening and treatment in low-income, primarily Hispanic baby boomers. J Health Care Poor Underserved. 2019;30:1068-1082.
An incremental cost-effecitveness ratio (ICER) was computed from the perspective of Medicare as payer, calculated over 20 years, and discounted at 3% per year.
- The cost of cure: barriers to access for hepatitis C virus treatment in south Texas. J Oncol Pract. 2019;15:61-63.
An editorial issue describes challenges that come with treating high risk populations for HCV.
- Modelling the potential prevention benefits of a treat-all hepatitis C treatment strategy at global, regional and country levels: a modelling study. J Viral Hepat. 2019;26:1388-1403. PMID:31392812.
A simulation model was designed to estimate the event, infections averted (IA), across 88 countries given the implementation of a treat-all strategy as published by WHO guidelines. The simulation indicated great IA benefits and researchers note the greatest benefit would be achieved by targeting people who inject drugs (PWID) populations.
- Decentralized care with generic direct-acting antivirals in the management of chronic hepatitis C in a public health care setting. J Hepatol. 2019;71:1076-1085. PMID:31325468
This study investigates the effectiveness of treating HCV infection in public health care settings. Primary care providers were trained to provide algorithm-based DAA treatment, and diagnose cirrhosis using clinical and radiological tools. SVR12 was achieved in 91.6% of patients.
- Predictive capacity for mortality and severe liver disease of the relative fat mass algorithm. Clin Gastroenterol Hepatol. 2019;17:2619-2620. PMID: 30471459
BMI has been criticized for being an imperfect measurement of body fat composition, but recently a new algorithm, the relative fat mass (RFM) was developed to better estimate the percentage of body fat. RFM was found to predict overall mortality and liver-related outcomes better than BMI.
- Optimizing use of nonalcoholic fatty liver disease fibrosis score, fibrosis-4 score, and liver stiffness measurement to identify patients with advanced fibrosis. Clin Gastroenterol Hepatol. 2019;17:2570-2580. PMID: 30876959
In a retrospective analysis, researchers found that a 2-step approach using either fibrosis score followed by liver stiffness measurement more accurately detected advanced fibrosis in populations with a low prevalence of advanced fibrosis (<10%). The liver stiffness score alone performed best in populations with a high prevalence of advanced fibrosis (24-50%).
- Cost effectiveness of hepatocellular carcinoma surveillance in patients with hepatitis C virus-related cirrhosis. Clin Gastroenterol Hepatol. 2005;3:75-84.
Researchers estimated the clinical and economic consequences of a common HCC surveillance strategy in patients with HCV-related cirrhosis in the context of alternative HCC treatment strategies.
- The hepatitis C virus care continuum: linkage to hepatitis C virus care and treatment among patients at an urban health network, Philadelphia, PA. Clin Gastroenterol Hepatol. 2019;70:476-486.
Researchers discuss the percentage of patients from various urban populations across nine steps of the HCV care continuum and factors associated with successful patient navigation.
Serving vulnerable or underserved populations
- HCV in women and pregnancy. Hepatol. 2019;70:1836-1840. PMID:31135999.
The article includes discussion of (1) prevalence of HCV in women of reproductive age, (2) interaction of pregnancy and maternal HCV infection, (3) effects of HCV infection on neonatal outcomes, (4) vertical transmission of HCV, and (5) future directions and needs for research.
- Perceptions of barriers and benefits of HCV treatment and correlates to treatment intention in methadone patients. J Health Care Poor Underserved. 2019;30:1433-1454. PMID:31680107.
In a study of HCV patients undergoing methadone maintenance treatment (MMT), it was found that attitudinal factors were more important than structural barriers in predicting HCV treatment-willingness.
- Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review. J Viral Hepat. 2019;[Epub ahead of print] PMID: 31638294
HCV care is not as robust as HIV care in prison populations; researchers highlight lessons to be learned from HIV care. A systematic review identifies individual-, provider-, and system-level barriers and facilitators to linkage to HCV care.
- Direct-acting antivirals for HCV treatment in older patients: A systematic review and meta-analysis. J Viral Hepat. 2019;26:1249-1256. PMID: 31243849
A systematic review was performed to evaluate the efficacy and safety of DAAs in patients aged 65 and older. Key findings about sustained virologic response, anemia, skin complaints, and direct-acting antivirals as they relate to older adults are discussed.
- National trends in hepatitis C infection by opioid use disorder status among pregnant women at delivery hospitalization – United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2019;68:833-838. PMID: 31581170
The US rate of HCV infection at delivery increased from 0.8 per 1,000 live births in 2000 to 4.1 in 2015. In 2015, rate of HCV infection is 216.9 per 1,000 deliveries for pregnant women with an opioid use disorder vs 2.6 per 1,000 deliveries among women without an opioid use disorder. Care for pregnant women with an opioid use disorder should include screening for HCV.
- Dietary patterns and risk of hepatocellular carcinoma among US men and women. Hepatology. 2019;70:577-586.
Prospective assessment of the associations of three key commonly used a priori dietary patterns, the Alternative Health Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet (AMED), and Dietary Approaches to Stop Hypertension (DASH).
- Ledipasvir/Sofosbuvir Effectively Treats Hepatitis C Virus Infections in an Underserved Population. Digestive Diseases and Sciences. Dig Dis Sci. 2018;63:3233-3240.
Researchers estimate sustained virologic response (SVR) following treatment with sofosbuvir-based regimens for HCV infections among underserved individuals and summarized the frequency of SVR across published studies of underserved populations.
Treatment access and considerations
- Hepatitis C: 5 things to know. Medscape Internal Medicine. 2019.
This article highlights fve key facts to help providers understand the big-picture with HCV and HCV treatment.
- Real-life effectiveness and safety of sofosbuvir/velpatasvir/voxilaprevir in hepatitis C patients with previous DAA failure. J Hepatol. 2019;71:1106-1115. PMID:3143303
The effectiveness of SOF/VEL/VOX in treating HCV infection is confirmed in this study including 179 infected patients. Undetectable HCV RNA was achieved by 75% of patients at weeks 4 and 99% of patients at week 12. Adverse events were minor and experienced by a small percent (4-6%) of patients.
- Daily aspirin use reduces risk of fibrosis progression in patients with nonalcoholic fatty liver disease, providing new uses for an old drug. Clin Gastroenterol Hepatol. 2019;17:2650-2651. PMID:31252189.
Estimates indicate that 20-30% of persons with NAFLD develop nonalcoholic steatohepatitis, which is directly associated with end-stage liver disease, HCC, and liver transplantation. This editorial reviews the use of low-dose aspirin as a method of preventive pharmacological therapy owed to its anti-inflammatory and anti-platelet properties.
- Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: A systematic review and meta-analysis. J Hepatol. 2019;71:473-485. PMID: 31096005
A systematic meta-analysis reviews differences in cure rate and other treatment outcomes between HCV patients with and without liver cancer.
- Short duration pan-genotypic therapy with glecaprevir-pibrentasvir for six weeks among people with recent HCV infection. Hepatol. 2019;[Epub ahead of print]. PMID: 31652357
Glecaprevir-pibrentasvir for six weeks was highly effective among people with acute and recent HCV infection, supporting further evaluation of shortened duration pan-genotypic therapy in this setting.
- Association of antiviral therapy with risk of Parkinson disease in patients with chronic hepatitis C virus infection. JAMA Neurology. Published online June 5, 2019. PMID: 31168563
In this cohort study of 188,152 patients with HCV, the group treated with antiviral therapy had lower incidence density and risk of developing Parkinson Disease (PD) compared with the untreated group.
- Expert opinion on managing chronic HCV in patients with neuropsychiatric manifestations. Antiviral Therapy. 2018;23:47-55. PMID: 30451150
Neurological manifestations of HCV infection appear to be under-recognized in clinical practice despite the majority of HCV-infected patients experiencing symptoms such as fatigue, depression and cognitive dysfunction.
- A pilot study of safety and efficacy of HCV retreatment with sofosbuvir/velpatasvir/voxilaprevir in patients with or without HIV (RESOLVE STUDY). J Hepatol. 2019;71:498-504. PMID: 31173815
Retreatment with 12 weeks of SOF/VEL/VOX was safe and effective in patients with relapsed HCV following initial combination DAA-based treatment. Treatment response was not affected by HIV co-infection or previous treatment course.
- Indelibly stamped by hepatitis C virus infection: persistent epigenetic signatures increasing liver cancer risk. Gastroenterology. 2019;156:2130-2133.
Liver cancer risk among patients who achieve a sustained virologic response after interferon or DAA treatment is discussed.
- Lack of Patient Compliance in Real-World Practice Negatively Affects Sustained Viral Response Rates to Direct Acting Agent Therapy for Hepatitis C. Digestive Diseases and Sciences. Dig Dis Sci. 2018;63:3228-3232.
Researchers assess the true efficacy of direct acting antiviral (DAA) therapy in real-world clinical practice, taking into account patients that do not complete therapy or the necessary follow-up to establish sustained viral response (SVR).
- Sofosbuvir, Velpatasvir, and Voxilaprevir for previously treated HCV infection. N Engl J Med. 2017;376:2134-2146.
The rates of sustained virologic response (SVR) are compared between three active-treatment groups; common adverse events are discussed.
- Oral combination therapies for hepatitis C virus infection: successes, challenges, and unmet needs. Annu Rev Med. 2017;68:345-358.
As the current standard of care for treatment of HCV consists of interferon-free DAA regimens, DAA cominations, and fixed-dose combinations, viral eradication rates are approaching 100% for various HCV-infected populations. Remaining patient subgroups with unmet medical needs are discussed.
- Hepatitis C in chronic kidney disease – an overview of the KDIGO guideline. Clin Gastroenterol Hepatol. 2019, in press.
The updated 2018 guidelines for prevention, diagnosis, and management of HCV in chronic kidney disease and future research needed for definitive recommendations are discussed.
- Patients with signs of advanced liver disease and clinically significant portal hypertension do not necessarily have cirrhosis. Clin Gastroenterol Hepatol. 2019;17:2101-2109.
The association between hepatic venous pressure gradients (HVPGs) and cirrhosis are investigated using histologic findings as the reference standard.
- Statin use after diagnosis of hepatocellular carcinoma is associated with decreased mortality. Clin Gastroenterol Hepatol. 2019;17:2117-2125.
Post-diagnosis statin use and its relationship to reduced risk of death in patients with HCC is analyzed and discussed.
- Assessing the burden of illness of chronic hepatitis C and impact of direct-acting antiviral use on healthcare costs in Medicaid. Am J Manag Care. 2019;25:S131-S139. PMID: 31211526
The cost of a complete DAA treatment course, at 2018 estimated net prices, can be expected to be fully offset by healthcare cost savings after only 16 months, on average, on a per-person basis. Given the value of DAAs, Medicaid policies should not restrict access to treatment based on disease severity or other requirements.
- Critical challenges and emerging opportunities in hepatitis C virus research in an era of potent antiviral therapy: considerations for scientists and funding agencies. Virus Res. 2018;248:53-62.
Does HCV research still need funding given the >95% success rate of DAAs? Researchers discuss barriers to eradication and research needed to solve ongoing issues with HCV treatment and cure.