All posts by Hep C TIP

Hepatitis C Elimination is Possible and Essential

Hepatitis C Eliminate is Possible and EssentialTwelve years ago a neonatal nurse adopted Kagen, a blonde haired blue-eyed baby boy. He’s now tall, sports a buzz cut, and likes playing Pokemon Go and visiting Build-A-Bear.

With the desire to help people in rural Appalachia, Naomi became a registered nurse and had dreams of one day becoming a doctor. While working in the fast paced ICUs in Nashville, Naomi remembers often being stuck by needles and being covered in bodily fluids while helping patients.

As a boy, Abdel remembers lining up once a month with his classmates for injections against schistosomiasis, a parasitic disease spread by water snails in Egypt, where he lived. As he was afraid of needles, he always tried his best to be last in line and never wondered where the needle had been before it poked him.

Forty years ago, Julia gave birth to her first child, a daughter. After her daughter’s birth, Julia haemorrhaged and was saved by a blood transfusion.

Each one of the above people have families, hopes, dreams, plans to live until they are old and gray — we all do — and they probably still hold on to those dreams. However, until recently, those dreams may have seemed out of reach for them because of something else they also had in common. All four of them, Kagen, Naomi, Abdel, and Julia, had hepatitis C, a virus that easily passes through blood.

Hepatitis C is a serious and potentially life-threatening liver disease that can lead to liver cirrhosis, cancer, or liver failure. However, in many cases those life-threatening developments may only develop after years of having no symptoms at all or having hepatitis C symptoms that can be written off as symptoms of the normal process of aging.

The group most impacted by hepatitis C, some 60,000 in B.C., are baby boomers, those who were born between 1945 and 1965. Many have lived with the infection for years but have never been tested or treated because they have never believed themselves to be at risk. Having the virus has just never crossed their minds as hep C symptoms can often take decades to emerge and when they do can just seem to be normal signs of aging.

Thankfully, testing for the virus is quick, easy, and can be done confidentially and at home. Thankfully, there are now new pills able to cure it.

With these services and treatments, British Columbia now has the opportunity to achieve a huge public healthcare feat. B.C. can avoid the cost of increased rates of liver cancer, end stage liver disease, and the consequences of hepatitis C’s symptoms, just by seeking out those carrying the hepatitis C virus and treating them.

However, as the virus can quickly and quietly spread, identifying those with the virus in B.C. and treating everyone infected, in a relatively short period of time, is the best way to eliminate it. In 2015, Prince Edward Island, for example, as well as other areas around the world, adopted this strategy and proved that hepatitis C elimination is possible. They proved that eliminating the hepatitis C virus should now be the world’s only course of action against the virus and that British Columbia should adopt a strategy of elimination as soon as possible.

For more information about hepatitis C and its cures, please visit the Hepatitis C Treatment Information Project.


Sources:
CBC News. $5M hepatitis C strategy announced by P.E.I. government. Feb 12, 2015. http://www.cbc.ca/news/canada/prince-edward-island/5m-hepatitis-c-strategy-announced-by-p-e-i-government-1.2954701 Accessed on Mar. 2017.
Everyday Health. Singer Naomi Judd Raises Her Voice on Hepatitis C. July 2014, http://www.everydayhealth.com/columns/my-health-story/singer-naomi-judd-raises-her-voice-hepatitis-c/. Accessed Mar. 2017.
“Generation Hep”. Generationhep.com. Accessed Mar. 2017.
McNeil, Donald. “Curing Hepatitis C, In An Experiment The Size Of Egypt”. Nytimes.com, 2015, https://www.nytimes.com/2015/12/16/health/hepatitis-c-treatment-egypt.html?_r=0 Accessed on Mar. 2017.
Southeast Missourian. Thankful people: Kagen Hill cured of hepatitis C, 2016, http://www.semissourian.com/story/2363041.html. Accessed Mar. 2017.

Relapse, Recurrence, Null & Partial Response/rs: The Basics

Relapse, Recurrence, Null & Partial Response/rs: The BasicsIn hepatitis C and hep C treatment there are three ‘R’s that are big, sad, and scary. They are the bringers of sadness that if doctors, friends, and communities could protect someone from, they would.

The Three ‘R’s of Hepatitis C Treatment

Recurrence
When treatment has been successful but over time the person has been infected with the hepatitis C virus again.

Relapse
When treatment has been successful but over time the virus has come back.

Null/Non Response/rs & Partial Response/rs
A null response is when treatment doesn’t work to suppress the virus. The viral count of hep C in one’s blood doesn’t decrease. Those with a partial response saw the hep C decrease at week 12 but undesirably high levels of virus in the blood at week 24. Both types of patients went through unsuccessful hep C treatments.

Peer Supports, Support Groups, and Online Forums

Whether hep C patients and/or their supports are facing recurrence, relapse, or non-response, there are a number of support groups and hotlines available to support you and to answer your questions. Also, going online is a great way to find local groups and connect to communities through social media, especially on Facebook.

Additional Information

Small Sampling of Journal Articles and Abstracts
Blog Posts

However, something to note is that this blog post was written a couple of months ago and since then, new and better treatments have become available and are covered by BC PharmaCare.

 

Technivie and BC PharmaCare

Technivie and BC PharmaCareTechnivie, the hepatitis C treatment, was approved for use in Canada in October 2015 and then later went on to pursue approval for BC PharmaCare coverage in January 2016. However, negotiations that may have led to BC PharmaCare coverage being granted in the near future were closed as an agreement couldn’t be reached between AbbVie and pCPA at this time.

Technivie is still an approved hepatitis C genotype 4 treatment in Canada. For more information about this, please contact the AbbVie Care program at: 1-844-471-2273.

Technivie (Ombitasvir / Paritaprevir / Ritonavir)

Technivie Background: Hepatitis C genotype 4 only accounts for about 13% of global hep C infections and isn’t as common in Canada as it is in the Middle East and Africa. However, due to increased travel and immigration, the population who have hep C genotype 4 and who live in high-income countries  is growing.

Targeted HCV Genotype:  4

Targeted Patients: Those without liver problems, or with Child-Pughs A, who have never tried hep C treatment or have previously tried peginterferon and ribavirin but weren’t cured by it.

Generic Name:  Ombitasvir / paritaprevir / ritonavir

Treatment Description:  Technivie is made up of 2 direct acting antivirals (ombitasvir and paritaprevir) and ritonavir, a booster for paritaprevir. It is taken without interferon.

Approximate Sustained Viral Response / Cure Rate:  100% with ribavirin, 91% without ribavirin

Daily Dose:  2 pills taken once in the morning with food + ribavirin taken once in the morning and once at night

Length of Treatment:  12 weeks

Thank you to all of those who wrote in for Technivie’s patient input reports that were sent to CADTH and BC PharmaCare. Thank you also to those who worked to develop Technivie, a treatment for hepatitis C genotype 4. Thank you for working in hopes of a better tomorrow for those with hepatitis C genotype 4.

Holkira Pak and BC PharmaCare

Holkira Pak and BC PharmaCareThe hepatitis C treatment Holkira Pak was approved for use in Canada in March 2015 and then was later approved for BC PharmaCare coverage in July  2015. Although Holkira Pak is still approved for use in Canada and has an amazingly high cure rate, as of March 23, 2017, BC PharmaCare has decided not to approve new requests for coverage.

For patients whose coverage was approved before March 23, 2017, BC PharmaCare will continue coverage until their current Special Authority expires. For more information about this change, please contact your doctor, nurse, or call the AbbVie Care program at: 1-844-471-2273.

From all of the BC residents who were able to access Holkira Pak and, therefore, may have been cured of the hepatitis C virus, we would like to thank all of the people who work within the hepatitis C approval pipeline who made their recovery possible.

Holkira Pak

Treatment Description: Holkira Pak is a treatment for patients with chronic genotype 1 hep C, including those with cirrhosis. It is an all-pill, short-course, interferon-free treatment that can be taken with or without ribavirin.

  • Ombitasvir / Paritaprevir / Ritonavir +/-
  • Ribavirin

Daily Dose: 4 pills +/- ribavirin pills

Sustained Viral Response (SVR)/”Cure Rate”: 95 – 100% with ribavirin

Usage Warning: Holkira Pak should not be taken with/by the following:

  • Those with moderate to severe liver impairment (Child-Pughs B and C);
  • Ethinyl estradiol-containing medicines (such as some birth control products);
  • Drugs that are sensitive cytochrome P450 (CYP) 3A substrates and for which elevated plasma concentrations;
  • Strong CYP2C8 inhibitors and inducers;
  • Moderate or strong inducers of CYP3A;
  • Recreational drugs.

Length of Treatment:

Genotype Previously Treated Cirrhosis Treatment # of Weeks
1a Yes or No No 2 pills once daily + 1 pill twice daily + 1 pill twice daily of RBV* 12
1b Yes or No No 2 pills once daily + 1 pill twice daily 12
1a/1b No Yes 2 pills once daily + 1 pill twice daily + 1 pill twice daily of RBV 12
1a Yes Yes 2 pills once daily + 1 pill twice daily + 1 pill twice daily of RBV 24**
*RBV stands for ribavirin. Holkira Pak with ribavirin is recommended for patients with an unknown genotype 1 subtype or with mixed genotype.
**24 weeks of Holkira Pak + ribavirin is recommended for patients with genotype 1a infection with cirrhosis who previously didn’t respond to pegylated interferon and ribavirin (PR).

Common Side Effects Reported in Clinical Trials:

  • Can’t sleep (insomnia)
  • Diarrhea
  • Headache
  • Itchiness
  • Nausea
  • Tiredness

Access to Hep C Treatment in Federal Institutions Webinar

Access to Hep C Treatment in Federal Institutions WebinarThursday, March 23rd at 11am PST,  join CTAC Policy Researcher Amanda Fletcher’s webinar to learn more about the prevalence of hepatitis C in Canada’s federal institutions.*

Hepatitis C impacts between 250,000-300,000 Canadians, among whom at least 44% are undiagnosed and untreated. While the national hep C burden among Canadians is approximately 1%, the prevalence of hep C in correctional institutions is estimated to be between 20 and 40%.

March 23rd CTAC Webinar

This CTAC webinar will focus on issues and recommendations around access to hep C treatment in federal institutions and address questions like: How has treatment, traditionally, been administered? What are the factors behind such a high hep C prevalence rate? What kind of preventative measures can be taken? How have Correctional Service Canada’s drug eligibility restrictions changed, and what does this mean for hep C treatment within the institutional setting?

Learn more about screening; treatment; harm reduction; social determinanents of health (gender, mental health/substance abuse); Correctional Service Canada’s new and less restrictive eligibility requirements around fibrosis scores; and, finally, CTAC’s recommendations for increasing treatment access.

Don’t delay. Register now!

On the day of the event, you will need to log on to the webinar at http://ctac.adobeconnect.com/hepCprison and dial in for the audio toll-free at 877-473-4906 with conference code 4564615148

CTAC

CTAC is an organization that focuses on access to treatment for people living with HIV and HIV/HCV co-infection. Since 1996, they have worked to secure and ensure equitable, affordable and timely access to treatment, care and support for people in Canada living with HIV and HIV/HCV co-infection.
*Content by CTAC

CROI 2017 by Lucinda K. Porter, RN

CROI 2017 by Lucinda K. Porter, RNLucinda K. Porter

This is a collection of blog posts written by Lucinda K. Porter, RN, a hepatitis C writer who attended this year’s Conference on Retroviruses and Opportunistic Infections (CROI). The blog posts below highlight hepatitis C studies presented at the conference that stood out to her.

Please scroll down and click on the blog tittles that interest you.

Sampling of CROI 2017 Meeting Highlights Written by Lucinda K. Porter, RN

CROI 2017

The Conference on Retroviruses and Opportunistic Infections (CROI), an annual preeminent HIV research meeting, was held in Seattle, Washington, February 13-16 this year. CROI gathers scientists researching epidemiology and biology of human retroviruses and associated diseases to discuss their findings.

More information about the CROI and the studies that were presented there can also be found in our blog post CROI 2017 Hep C Highlights Part I.

“Creating a world free from hepatitis C one step at a time” -Lucinda Porter

CROI 2017 Hep C Highlights Part II

CROI 2017 Hep C (HCV) HighlightsCROI 2017

The Conference on Retroviruses and Opportunistic Infections (CROI), an annual preeminent HIV research meeting, was held in Seattle, Washington, February 13-16 this year. CROI gathers scientists researching epidemiology and biology of human retroviruses and associated diseases to discuss their findings.

This blog post is a collection of HIV/HCV highlights that were presented at CROI 2017. Please scroll down and click on the subjects that interest you.

More Interesting CROI 2017 Abstracts about HIV/HCV Coinfection

More information about The Conference on Retroviruses and Opportunistic Infections (CROI), or these and other studies can be found in our blog post CROI 2017 Hep C Highlights Part I or on the conference’s website.

CROI 2017 Hep C Highlights Part I

CROI 2017 Hep C Highlights Part ICROI 2017

The Conference on Retroviruses and Opportunistic Infections (CROI), an annual preeminent HIV research meeting, was held in Seattle, Washington, February 13-16 this year. CROI gathers scientists researching epidemiology and biology of human retroviruses and associated diseases to discuss their findings.

This blog post is a collection of HIV/HCV highlights that were presented. Please scroll down and click on the subjects that interest you.

Interesting Meeting Abstracts about HIV/HCV Coinfection

More information about The Conference on Retroviruses and Opportunistic Infections (CROI), or these and other studies can be found in our blog post CROI 2017 Hep C Highlights Part II or on the conference’s website.

PHCN’s Statement about the Successful Negotiations for 3 New Hepatitis C Treatments

PHCN's Statement about the Successful Negotiations for 3 New Hepatitis C Treatments‘No One Left Behind!’

Pacific Hepatitis C Network (PHCN) is very happy to learn that effective March 21, an extensive list of hepatitis C treatments will be available through BC PharmaCare – at far better prices than they previously had been. The high cost of hepatitis C treatment has effectively restricted the numbers of people living with hepatitis C who could access treatment.

Even with lower prices, those restrictions will remain in place until next year. Come March 2018, those restrictions (requiring a liver fibrosis stage of F2 or greater) will be lifted and hepatitis C treatment will be available to any person living with hepatitis C in BC, “regardless of the type and severity of their disease”.

The Province, via the Ministry of Health, co-led the negotiations for new, affordable prices and we at PHCN are both proud of that fact and sincerely grateful. We hope the same for new, hep C drugs that are currently in development and that improve even more on cure rates, tolerability, length of treatment, and treating more than one HCV genotype.

And with these new developments, our work continues! Now is the time to identify and address the barriers still in place that keep those living with hep C from accessing care and treatment: low levels of primary care provider awareness of hep C and treatments; believes about who deserves treatment and who doesn’t; patient education and outreach to those who were diagnosed years ago but are not engaged in care for their hep C. Stigma can and does underlay many of those barriers and must be addressed.

PHCN applauds the ushering in of the first critical step by BC’s Ministry of Health and we urge continued vigilance and collective planning and action to ensure ’No One Left Behind!’ when it comes to hepatitis C care and treatment in BC.

More information can be found here.

Successful Negotiations for Three New Hepatitis C Treatments

Successful Negotiations for Three New Hepatitis C TreatmentsDirectly copied statement from the pan-Canadian Pharmaceutical Alliance

TORONTO, Feb. 21, 2017 /CNW/ – On behalf of participating federal, provincial and territorial public drug plans, the pan-Canadian Pharmaceutical Alliance (pCPA) has concluded successful negotiations with three drug manufacturers to help jurisdictions expand access to publicly funded medications for the treatment of chronic hepatitis C.

Hepatitis C is a communicable liver disease that is caused by an infection with the hepatitis C virus. Seventy-five per cent of people who have contracted hepatitis C cannot spontaneously clear the virus. This leads to chronic hepatitis C infection. Although many of the estimated 250,000 infected Canadians may have no symptoms for decades, if left untreated, chronic hepatitis C can lead to serious complications such as liver failure and liver cancer.

Just a few years ago, hepatitis C patients took a combination of pills and injections for almost a year and these earlier drugs had lower rates of treatment success. Today’s newer therapies are more effective, available in oral form and require substantially shorter durations of treatment.

These benefits, however, come at a substantial cost. Depending on the drug and disease progression, the list cost for hepatitis C treatments ranged from $45,000 to over $100,000 per patient. Although these costs were made more affordable with previous agreements, the funding of hepatitis C treatments has resulted in significant cost pressures.

Recently, multiple products have become available, creating a more competitive environment for hepatitis C treatment price negotiations.

The pCPA’s approach to hepatitis C treatment negotiations was guided by the following:

  • goal of providing treatment for patients regardless of genotype and disease severity
  • financial affordability and sustainability
  • a fair approach in negotiating value among multiple drugs and manufacturers.

Gilead Sciences Canada, Merck Canada, and Bristol-Myers Squibb Canada were able to reach an agreement through the pCPA to provide hepatitis C drugs at an improved cost. These agreements will help increase publicly funded access for most patients with hepatitis C.

As with all pCPA drug negotiations, individual participating jurisdictions will be responsible for implementing changes under their respective public drug plans.

SOURCE Pan Canadian Pharmaceutical Alliance (pCPA)

For further information: For more information (media): David Jensen, Ministry of Health and Long-Term Care, 416-314-6197