Early treatment for hepatitis C

All people with chronic hepatitis C virus (HCV) infection should start therapy with direct-acting antivirals, research published in the online edition of Clinical Infectious Diseases suggests. Investigators from the United States found that individuals with moderate fibrosis had an increased risk of mortality, and that there was no accurate way of predicting disease progression of fibrosis from mild to moderate.

The study followed 964 people with HCV for a median of 5.9 years after a first measurement of liver stiffness. The study found that people with moderate fibrosis (liver stiffness score between 8 and 12.3) were 42% more likely to die than people with mild or no fibrosis during the follow-up period. For every hundred people with moderate fibrosis, 3.5 died for each year of follow up, compared to 2.2 of those with mild or no fibrosis.

The study found that although changes in liver stiffness measurement predicted who would subsequently progress from mild to moderate fibrosis, 28% of people who would progress from mild to moderate fibrosis would be missed if annual changes in liver stiffness measurement were used to predict progression. Insurance company restrictions that withhold treatment for people with mild fibrosis are unsound, the authors conclude, because it is not possible to predict with sufficient accuracy who will progress to moderate fibrosis and hence to an increased risk of death.

The study authors say that their findings support current US guidelines developed by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), which recommend treatment for everyone with hepatitis C including those with mild fibrosis.

Access to hepatitis C treatment in South East Asia

Co-infection with HIV is common in people with hepatitis C in South East Asia. Now, a study of people receiving HIV treatment in Thailand, Vietnam, Indonesia and Malaysia has found that almost two-thirds of people with HIV and HCV co-infection are in need of HCV treatment. One in five people with co-infection have cirrhosis, investigators report in the Journal of Viral Hepatitis. The most common HCV genotypes were genotypes 1 (59%) and 3 (26%). The majority of people were taking antiretroviral therapy with good immunological and virological outcomes.

Access to hepatitis C treatment in South East Asia remains limited owing to the high cost of direct-acting antivirals in the middle-income countries of the region. A regimen of pegylated interferon and ribavirin continues to be the predominant form of treatment on offer.


Hepatitis C virus (HCV) infection is associated with a range of non-liver-related cancers in older people, investigators from the United States report in Cancer. The study population comprised over 1.6m people with cancer who were over the age of 66 and a control group of 200,000 closely matched people who did not have cancer. Overall, cancer incidence was higher among people with HCV antibodies, as was incidence of several specific malignancies including cancers of the liver, bile ducts, pancreas, certain skin cancers, myelodysplastic syndrome, and diffuse large B-cell lymphoma.

Another recently published study shows that the risk of some types of cancer is also higher in people with HIV and HCV co-infection. The study, conducted in Spain, found that after excluding liver cancer and AIDS-related cancers, people with HIV and HCV co-infection had a 26% increased risk of cancer when compared to people with HIV alone. The study followed people for 12 years.

Liver cancer and treatment for viral hepatitis

Liver cancer may develop despite successful treatment of hepatitis C, as a result of damage to the liver sustained prior to treatment. There has been conflicting evidence about the risk of liver cancer after hepatitis C is cured. A few studies have indicated that the risk of developing liver cancer may be higher in people with cirrhosis who have taken direct-acting antiviral treatment, even in those who achieve a viral cure. A higher rate of recurrence of liver cancer has also been reported. However, large studies in people infected with HCV alone have failed to show an increased risk of liver cancer.

Further reassurance has been provided by studies in people with HIV and hepatitis C virus (HCV) co-infection. A Spanish study found no increased risk of liver cancer for people with co-infection who achieved a cure of hepatitis C with direct-acting antivirals or interferon-based treatment. An Italian study found no difference between people with HCV mono-infection and people with HIV and HCV co-infection in the risk of developing liver cancer after successful treatment.

In people with hepatitis B receiving treatment with entecavir or tenofovir, a national study of 65,000 people in Taiwan has found that liver cancer has declined by 27% for each year of treatment. The study also found that the risk remained higher in people with cirrhosis, in men, in older people, in people with diabetes and in people with HIV co-infection. These groups should all be prioritised for regular screening for liver cancer during hepatitis B treatment, the researchers concluded.

A study carried out in Europe found that the risk of liver cancer fell substantially after five years of treatment, while a study of people with hepatitis B in the United States who underwent a liver transplant found that the likelihood of a transplant fell between 2005 and 2015, after the introduction of entecavir and tenofovir.

Direct-acting antiviral treatment achieves high cure rates in the most advanced liver disease patients with HIV co-infection

People with HIV and hepatitis C virus (HCV) co-infection with liver cirrhosis or liver failure, and those who received liver transplants, saw high rates of sustained virological response using interferon-free direct-acting antiviral (DAA) therapy for hepatitis C, according to three Spanish studies presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) last month in Seattle.

One study showed that 98% of previously untreated people and 89% of treatment-experienced people with decompensated cirrhosis were cured with various DAA regimens in one Spanish cohort study. Cure rates were 95% or higher for all regimens except sofosbuvir and simeprevir without ribavirin for 12 weeks (63%). A second study found a lower cure rate (81%) in people with decompensated cirrhosis, due to treatment of a larger number of people with the most advanced cirrhosis (Child Pugh C). A third study found that people with co-infection who underwent a liver transplant were just as likely to respond to post-transplant DAA treatment as people with mono-infection.

Taken together, these studies show that people with decompensated cirrhosis and liver transplant recipients can be treated using some of the same DAA combinations as people with less advanced liver disease, but they may need to add ribavirin or lengthen the duration of therapy.

Glecaprevir/pibrentasvir combination does not interact with HIV medications

AbbVie's investigational glecaprevir/pibrentasvir treatment for hepatitis C is not expected to interact with or require dose adjustment when taken with commonly used antiretroviral regimens, offering a new option for people with HIV and hepatitis C virus co-infection, according to a study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2017) last month in Seattle.

A study in healthy volunteers found no significant drug interactions with commonly prescribed antiretroviral drugs.

The combination is being considered for marketing approval in the European Union and United States.

Hepatitis A outbreak in Europe

The European Centre for Disease Prevention and Control (ECDC) has reported an outbreak of hepatitis A among men who have sex with men in 13 European countries. Three clusters of infections had been reported by the end of February 2017 involving 287 people, linked mainly by sexual contact. Many of the cases are associated with recent travel to Spain, or sexual contacts in Amsterdam or Germany, but each cluster involves people in between seven and ten European countries. Sexual transmission is considered to be the cause, although several cases of household transmission have been identified.

ECDC emphasises the importance of offering and promoting hepatitis A vaccination to men who have sex with men, and of maintaining sufficient vaccine stocks to respond to outbreaks.

Hepatitis C community summit, 18 & 19 April, Amsterdam

The Hepatitis C Community Summit will take place on 18 & 19 April in Amsterdam, immediately prior to the International Liver Congress.

The summit will bring together medical experts, researchers and representatives of harm reduction and community services to discuss the needs, gaps and opportunities to make treatment available for all people in need. Attendees will also present community approaches for testing and treatment for HCV (and B) and discuss and agree on further community action and advocacy.


  • To provide a platform for all those involved in HCV treatment.
  • To create synergy with the International Liver Congress conference and its attendees.
  • To develop an enduring cooperation in building the road to eradication.
  • To launch a consensus statement on community inclusion.

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