Dr. David Mazoff

Dr. David Mazoff

It is with regret that we announce that Dr. Mazoff has retired from the Hepatitis C Support Project (HCSP)/HCV Advocate effective September 30, 2015. We are happy for David, but he will be missed by all of us at HCSP and the hepatitis C community.

David became a full-time employee of HCSP/HCV Advocate on January 01, 2003 although he did volunteer work for us prior to his official start day. David’s responsibilities included webmaster, general editor, and production of our fact sheets/guides, and newsletters, and many additional duties.

From the beginning, David raised our game.  He was an important part of our growth from a small local group in San Francisco, CA to a large national advocacy organization. He helped us implement a new website in early 2000’s, and he designed and implemented our current site that we launched in September 2015.

David took on many duties throughout the years that included the production of our fact sheets, guides, and our newsletters. David also was in charge of posting news items to our blog and many, many more duties.  His shoes will be hard to fill.

David lives in Victoria, B.C., Canada.  He will be spending time playing swing jazz, Latin jazz and Argentine tango with his accordion.  His aim is to join a group and play professionally.  He also plans on hiking, bird watching and volunteering for HepCBC in his spare time.  Knowing David he will accomplish all of his wish list and much more.

We wish David the best of luck as he lives his so-called retirement to the fullest.  I hope that David realizes how much his work has helped thousands of people with hepatitis C and B.

If you happen to run into David, give him a big ole Canadian ‘hi’ and a bear hug for all his great work.

Alan and the staff of the
Hepatitis C Support Project/HCV Advocate

[HAP] NASTAD Releases White Paper on Drug User Health and ACA Opportunities‏

With generous support from the Elton John AIDS Foundation, NASTAD is pleased to announce the release of a new white paper: Modernizing Public Health to Meet the Needs of People Who Use Drugs: Affordable Care Act Opportunities. The paper assesses new financing and delivery models for drug user health services. Working with the O’Neill Institute for National & Global Health Law, the project team focused on coverage and financing opportunities for community-based drug user health and harm reduction services typically not covered by insurance. Research focused on eight states, assessing how health departments, community-based organizations, Medicaid programs and plans and hospitals are working together to better address the needs of people who use drugs.

The need to find creative solutions to ensure that broader health care systems and payers are providing prevention, care, and treatment services for people who use drugs comes in the midst of a public health crisis for this population. Rates of HIV infection and viral hepatitis are substantially higher among persons who use drugs than among persons who do not. Opioid use in particular in the United States is at epidemic proportions. This crisis – coupled with limited federal and state resources for drug user health programs and services – has made leveraging the ACA and partnerships with broader health systems and payers even more critical.

NASTAD has been awarded another year of Elton John AIDS Foundation funding to support a learning collaborative that builds off of the findings of the white paper and supports health departments to partner with broader health care systems and payers to increase access to drug user health services. To see more of NASTAD’s drug user health work, including our Statement of Urgency: Addressing the Opioid Epidemic in the United States and Minimizing Harm, Maximizing Health: The Role of Public Health Programs in Drug User Health, please visit our website.

 For questions, please contact Amy Killelea at akillelea@nastad.org

For more information, visit the NASAD Website.....

Cornell Studies Hepatitis C Populations Not Typically Tallied in Survey

New research highlights how government estimates on hepatitis C prevalence in the United States leave out about 1 million people from several groups not regularly included in the tally, say researchers from Cornell University.   

The government estimates are from a 2014 report of the National Health and Nutrition Examination Survey (NHANES), a health assessment from a representative sample of the country’s population, according to an article posted on the university web site. Out of an estimated 3.6 million people who have the hepatitis C virus antibodies, the survey indicates that 2.7 million are currently infected with the virus.  

Results of a study from Weill Cornell Medicine published this month in the journal Hepatology say that a closer analysis of data from various sources revealed that the government estimate excludes six populations, including some that are stigmatized and live on the margins of society. The study authors say that the number of US residents who have antibodies for hepatitis C is probably closer to or exceeding 4.6 million and that 3.5 million are infected

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Medication Adherence Trial In Hepatitis C Patients Launched

A new medication adherence application from emocha helps keep HCV patients on track.

According to the CDC, approximately three to four million individuals are chronically infected with Hepatitis C Virus (HCV) in the United States and at least three quarters of those who become infected will develop chronic infection which, if left untreated, can produce long-term complications and even death.

HCV therapy has been revolutionized by recent developments in treatments, including oral options that achieve high levels of HCV cure when taken as directed. That means medication adherence is a high priority for both healthcare providers and payers, both in terms of the potential benefits and because of the high costs of these medications, which can be up to $1,000 per pill or more than $80,000 for an entire course of treatment.

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AASLD / IDSA Guidance - Treat All Patients with Chronic Hepatitis C

WHEN AND IN WHOM TO INITIATE HCV THERAPY

Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure, and as such, is expected to benefit nearly all chronically infected persons. When the US Food and Drug Administration (FDA) approved the first IFN-sparing treatment for HCV infection, many patients who had previously been “warehoused” sought treatment, and the infrastructure (experienced practitioners, budgeted health-care dollars, etc) did not yet exist to treat all patients immediately. Thus, the panel offered guidance for prioritizing treatment first to those with the greatest need. Since that time, there have been opportunities to treat many of the highest-risk patients and to accumulate real-world experience of the tolerability and safety of newer HCV medications. More importantly, from a medical standpoint, data continue to accumulate that demonstrate the many benefits, within the liver and extrahepatic, that accompany HCV eradication. Therefore, the panel continues to recommend treatment for all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV, by transplantation, or by other directed therapy. Accordingly, prioritization tables are now less useful and have been removed from this section.

Despite the strong recommendation for treatment for nearly all HCV-infected patients, pretreatment assessment of a patient’s understanding of treatment goals and provision of education on adherence and follow-up are essential. A well-established therapeutic relationship between practitioner and patient remains crucial for optimal outcomes with new direct-acting antiviral (DAA) therapies. Additionally, in certain settings there remain factors that impact access to medications and the ability to deliver them to patients. In these settings, practitioners may still need to decide which patients should be treated first. The descriptions below of unique populations may help physicians make more informed treatment decisions for these groups. (See sections on HIV/HCV coinfection, cirrhosis, liver transplantation, and renal impairment).

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Cures for hepatitis C are an investment worth making

New cures for hepatitis C are helping Medicare beneficiaries live longer, healthier lives. It is disingenuous to look at Medicare spending on these treatments without considering the substantial rebates and competition in the program [“Medicare spending for hepatitis C drugs surges,” news, Oct. 18].

Competition and robust negotiation in Medicare Part D are controlling costs. Private plans command steep discounts on prescription prices under Part D, including groundbreaking cures for hepatitis C. In fact, additional treatment options approved in the past year led to competition-generated savings for a variety of payers, including Medicare. Average rebates on some of these products increased from 22 percent in 2014 to 46 percent in 2015. Average rebate levels in Part D have increased each year of the program. Even the 2015 Medicare trustees report that rebates are substantial.

Moreover, researchers at Harvard University suggest new hepatitis C therapies may generate cost savings for the health-care system over the long run. Medicare is uniquely positioned to take advantage of these savings, as beneficiaries remain in the program once they become eligible.

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Harm Reduction Is Essential to Combat the Addiction Epidemic

Talking about injection drug use is not comfortable for many people. Yet nearly 7 million U.S. citizens inject drugs every year. For those who suffer from debilitating addictions, our silence is deafening. The majority of injection drug users are infected with either HIV or hepatitis C, both devastating illnesses with life-long consequences. Medically, they are at high risk for overdose and a multitude of diseases. Socially, they face enormous stigma, homelessness and violence. Each of them is someone's family. All of their lives matter.

What is there to be done? The good news is that for decades, both injection drug users and doctors have been advocating for harm reduction, a rational and proven way to reduce infections. The idea is simple: lower the risks associated with using drugs. Doctors use these principles every day in the clinic, such as when they encourage patients to use condoms and birth control. We've learned the hard way that abstinence-based methods actually increase risky sexual activity. By instead providing knowledge and safer-sex supplies, they make the behavior safer. Drug use is no different.

The main example of harm reduction for injection drug users is needle exchange, and like harm reduction in general, it's easy to understand. A needle exchange provides a safe, anonymous way for needle users to throw away old syringes, thus keeping them out of public parks and trash cans, where they may wind up otherwise. Next, needle exchanges provide a way to obtain clean injection supplies, so that clients are protected from disease. These simple operating principles have incredible, proven results among clients: a 33% reduction in the risk of contracting HIV, a 61% reduction in hepatitis B, and a 65% reduction in hepatitis C. If needle exchange was a prescription, it would a blockbuster

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