News & References

Below is a curated collection of recent literature and resources relevant to the national effort to address HCV and complex comorbidities within primary care.

Check back often as we are regularly updating these resources.

Select publications from our program

  • 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.

Clinical infrastructure

  • 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

  • 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

  • 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.

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.

Funding issues

  • 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.