Snapshots, by Alan Franciscus, Editor-in-Chief

Originally published July 1, 2015

Article: Long-term treatment outcomes of patients infected with Hepatitis C virus: a systematic review and meta-analysis of the survival benefit of achieving a Sustained Virological Response–B Simmons, et. al
  Source:  Clin Infect Dis. 2015 May 17. pii: civ396. [Epub ahead of print]

Results and Conclusions:  In the current study the authors conducted an electronic search to identify if achieving a cure improved long term outcomes. The records of 33,360 patients from 31 studies were examined with a medium follow-up period of more than five years. The people who were cured were compared to those who were not cured. 

The Bottom Line:  The survival after five years from being cured was significant compared with those who did not achieve a cure.  This included three populations of people—those who were HCV mono-infected, those who had cirrhosis and those who were coinfected with HIV and hepatitis C. 

Editorial Comment:  In science studies are needed for everything, and this is an important one because it proves that successful treatment works to prolong lives.  More of these studies (with larger patient populations) are required to convince insurance companies and other payers that in the long run paying for treatment saves them money and, more importantly, lives.

Article:  Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial—RD Josiah
  Source: The Lancet DOI: http://dx.doi.org/10.1016/S0140-6736(14)62338-2

Results and Conclusions:  Methadone is used for withdrawal/substitute for opioid use.  In this study people who were entering Rhode Island Department of Corrections and who were currently enrolled in a methadone maintenance program at the time of arrest were asked to enroll in a study that would continue them on methadone maintenance while they were in prison.  Participants were only included in the study if they were to be incarcerated for more than 1 week but less than six months.  The participants in the study were randomized by a computer-generated program by sex and race.  The trial took place between June 2011 - April 2013.  

• The 114 participants in the methadone maintenance group were randomized to receive methadone at their regular dose.

After release from prison the study paid for ten weeks of methadone for the methadone group if financial help was needed.

• The 109 forced-withdrawal group followed standard guidelines forforced withdrawal. 

The standard withdrawal protocol was to receive methadone for 1 week at the dose at the time of their incarceration, then a tapered withdrawal regimen (for those on a starting dose >100 mg, the dose was reduced by 5 mg per day to 100 mg, then reduced by 3 mg per day to 0 mg; for those on a starting dose >100 mg, the dose was reduced by 3 mg per day to 0 mg).

The Bottom Line: The participants who were given methadone were more than twice as likely than the forced withdrawal group to return to a community methadone clinic in their community within 1 month of release—96% vs. 78%.  There were no serious side effects in either group. 

• Methadone groups:  one death, one non-fatal overdose, one hospital admission and 11 emergency-room visits
• Forced-withdrawal groups:  no deaths, two non-fatal overdoses, four admissions to hospitals, 16 emergency-room visits

Editorial Comments:  Providing methadone seems very humane.  It also reduces hospital admission, emergency-room visits and greatly increases the chances that once a prisoner is released they would seek out a methadone clinic.

http://hcvadvocate.org/news/newsLetter/2015/advocate0715.html#3

Deferring hepatitis C treatment can lead to liver cancer and death, despite cure

HIV/HCV coinfected people who delay hepatitis C treatment remain at risk for liver failure, hepatocellular carcinoma and liver-related death even after being cured – with outcomes worsening the longer it is put off  – indicating that treatment should not be deferred until advanced disease, according to a presentation at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI) last week in Seattle. Treating only after progression to cirrhosis increased the risk of liver-related death by more than five-fold and the duration of infectiousness by four-fold.

Over years or decades chronic hepatitis C virus (HCV) infection can lead to advanced liver disease including cirrhosis (scarring), hepatocellular carcinoma (HCC; a type of primary liver cancer) and end-stage liver failure. People with HIV/HCV coinfection experience faster disease progression, on average, than those with HCV alone. Successful hepatitis C treatment reduces - but does not eliminate - the risk.

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