Georgia refuses Hep-C cure for poz guys

News in gay Atlanta of a drug that can eradicate previously incurable Hepatitis-C in 99 percent of cases was tainted last week by the state picking and choosing who can get it, excluding thousands of HIV-positive patients. It’s renewed a clarion call by activists to expand Medicaid.

The 12-week drug regimen known as V-Pak works, but it’s expensive – as much as $80,000 per patient. The National Alliance of State and Territorial AIDS Directors, which includes Georgia, negotiated a discount to about half price, but each state must decide whether or not to offer it under various programs.

In Georgia, that meant Hepatitis C patients under Medicaid will get V-Pak. But HIV-positive people with Hep C on ADAP, the HIV prescription assistance program, can’t. State agencies say they’re hamstrung by the cost to offer life-saving treatment to some and deny it to others, according to WABE.

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Portugal: Gov't reaches deal for Hepatitis C drug

The Portuguese government has finally reached an agreement with an American pharmaceutical firm to bring an innovative drug to treat Hepatitis C to Portugal. 

The deal comes one year after the drug from Gilead Sciences reached Europe.

According to reports the Ministry of Health and national drugs watchdog Infarmed managed to negotiated a price that will enable more patients to be treated for less than €25,000 per treatment.

Newspaper Público reports that the plan is to treat between 10,000 and 12,000 patients with the new drug over the next three years.

Source: http://theportugalnews.com/news/govt-reaches-deal-for-hepatitis-c-drug/33932

HIV rebound linked to liver fibrosis progression in HIV/HCV coinfected

HIV-positive people with hepatitis C virus (HCV) experienced progression to liver fibrosis if their HIV viral load rebounded above 1000 copies/mL or remained detectable on 2 consecutive tests, researchers reported in the January edition of HIV Medicine. Smaller transient HIV "blips," however, were not associated with worsening fibrosis. Optimized antiretroviral therapy, the study authors suggested, may protect the liver.

HIV/HCV coinfected people are known to experience more rapid liver fibrosis progression than people with hepatitis C alone, though the reason for this is not fully understood. SMART and other studies have shown that interruption of antiretroviral therapy (ART) and lack of HIV viral suppression are associated with liver, heart, and kidney disease, but it is not known what level of viremia affects liver fibrosis progression.

Curtis Cooper and fellow investigators with the Canadian Co-infection Cohort Study looked at the relationship between HIV viral load and fibrosis progression in 288 HIV/HCV coinfected people in the cohort. A majority (74%) were men, the mean age was 45 years, and the median CD4 T-cell count was 440 cells/mm³. Most (81%) reported a history of injection drug use and half currently drank alcohol.

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Can organ donations transplant personal qualities?

GRAND RAPIDS, Michigan (WZZM) — It's been a long-debated topic ever since organ transplants became possible: Can organ-donation recipients really inherit memories, talents, and qualities of the donor?

Dr. Michael Hagan believes it happens. In fact, he says he's living proof.

"It's not that I wished it to happen," Hagan says. "It just happened."

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Snapshots —Lucinda K. Porter, RN

Article: Next-Generation Sequencing Sheds Light on the Natural History of Hepatitis C Infection in Patients Who Fail Treatment – Tamer Abdelrahman, et al.
  Source: Hepatology January 2015; Volume 61, Issue 1, pages 88–97

Reports show high rates of HCV reinfection among injecting drug users with history of HCV, along with reports of sexually transmitted HCV infection and reinfection in HIV-infected men who have sex with men. This research investigated viral quasispecies dynamics in patients who failed HCV treatment to determine whether treatment failure was associated with reinfection or reemergence of preexisting infection. Previous studies interpreted the evidence as reinfection; this study identified the subjects as having preexisting resistant HCV variants.

 

The Bottom Line: Resistant HCV strains are more likely the reason for failure to achieve a sustained virological response (SVR) in these study subjects. This could be the result of superinfection or a limitation on the ability to test these HCV strains.

 

Editorial Comment: Few words cause as much fear in me as “superinfection.” What this study did not discuss is whether the lack of SVR could be connected to immune factors in this study group.

Article: Association between Chronic Hepatitis C Virus Infection and Low Muscle Mass in US Adults – Charitha Gowda, et al.
  Source: Journal of Viral Hepatitis December 2014; Volume 21, Issue 12, pages 938–943

The purpose of this cross-sectional study was to see if chronic hepatitis C virus (HCV) infection was associated with low muscle mass among adults.

Among 18,513 adults in the U.S., people with chronic HCV had a higher prevalence of low muscle mass compared to uninfected persons (13.8% vs. 6.7%). Even HCV+ persons without significant liver fibrosis had lower muscle mass.

 

The Bottom Line: Chronic HCV infection is associated with low muscle mass, even in the absence of advanced liver disease.

 

Editorial Comment: Low muscle mass is a risk factor for osteoporosis. This study strengthens the argument that we should treat people with chronic HCV, regardless of fibrosis stage.  

Article: The Epidemiology of Cirrhosis in the United States: A Population-based Study – Steven Scaglione, et al.
  Source: Journal of Clinical Gastroenterology published ahead-of-print October 8, 2014

Hepatitis C is one of many conditions that can cause cirrhosis, a severe scarring of the liver. This study assessed the prevalence of cirrhosis in the US, and defined some of the characteristics of this potentially deadly condition.

The prevalence of cirrhosis is higher in the U.S. than previously estimated (633,323 now versus previously estimated 400,000 adults). The researchers believe that the prevalence is even higher since this research relied on data from the NHANES survey, which did not collect data from people who were in the military, prison, hospitalized, homeless, or institutionalized.

Alcohol abuse, diabetes and hepatitis C were contributing factors for the majority of those with cirrhosis.  Non-Hispanic blacks and Mexican Americans, those living below the poverty level, and those with less than a 12th grade education had the highest prevalence of cirrhosis. Nearly 70% of those who have cirrhosis may not know they have it.

 

The Bottom Line: The prevalence of cirrhosis is significantly higher than previously thought.

 

Editorial Comment: The most common factors associated with cirrhosis are preventable – hepatitis C, diabetes, and alcohol abuse. Hepatitis C is curable; a public health program that identifies and cures this virus may reduce the burden of cirrhosis.

Article: Cognitive Function and Endogenous Cytokine Levels in Children with Chronic Hepatitis C – N. H. Abu Faddan, et al.
  Source: Journal of Viral Hepatitis published ahead-of-print December 15, 2014

Hepatitis C is rarely studied in children, and little is known about the cognitive effects of hepatitis C in young patients. This Egyptian study compared cognitive function in 35 HCV-positive children to 35 HCV-negative children. Compared to HCV-negative children, the children with HCV had reduced function in the areas of vocabulary, comprehension, memory, abstract visual reasoning test, quantitative reasoning test, and intelligence quotients.

 

The Bottom Line: Children with chronic HCV in its early stages showed signs of cognitive impairment, particularly with memory. There appeared to be a correlation between cognitive function and immune response as measured by the production of cytokines.

 

Editorial Comment: This study is particularly heart breaking. Children are often the last to be studied, and the last to be treated. We tend to be afraid to treat children, understandably concerned that we may injure them. This study represents the tip of the iceberg, telling us how little we know about HCV in children.

 

Article: Impact of Hepatitis C Virus Infection on the Risk of Death of Alcohol-Dependent Patients – Daniel Fuster, et al.
  Source: Journal of Viral Hepatitis January 2015; Volume 22, Issue 1, pages 18–24

This longitudinal research assessed the relationship between chronic hepatitis C virus (HCV) infection and survival rates. There were 675 subjects (nearly 80% male), enrolled in two detoxification units, with a median follow-up of three years. 

The Bottom Line: The mortality rate was high for those with alcohol-related liver disease, regardless of HCV-status; more than 11% died (78 subjects). Risk of death was increased among younger HCV-positive participants compared to those who were HCV-negative. HCV/HIV co-infection was associated with increased risk of death.

 
Editorial Comment: This study speaks for itself. I can only add that if alcohol is a problem for you, please get help.


http://hcvadvocate.org/news/newsLetter/2015/advocate0215.html#5

HCV Drug Pipeline Updated

We have recently updated our Drug pipeline—Quick Reference Guide & Detailed Reference Guide. As you will see the HCV pipeline is very robust with many new studies.  The current treatments can cure more than 90% of people who can access treatment.  There will be even more drugs approved in 2015 and beyond so the future looks incredibly bright.   Alan

Quick Reference Guide

Detailed Reference Guide

Prices for the miracle drugs that cure Hepatitis C are collapsing

When California based Gilead Sciences announced a breakthrough treatment in late 2013 that cures most kinds of Hepatitis C, people were outraged at the cost: $84,000 in total, or nearly $1,000 a pill.

There are more expensive drugs, but Gilead Science’s hepatitis drugs’—Sovaldi and Harvoni—combination of eye-popping price, sales, and patient population (100 million plus worldwide) is unprecedented (paywall).

 
But on February 3rd, Gilead announced in its quarterly earnings call that it expects to cut the price of its Hepatitis C drugs an average of 46% this year in the US. That’s double last year’s discount. Some government plans will pay less than half the list price for Harvoni (a Gilead follow up treatment that combines Sovaldi’s active ingredient with another drug).

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