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Liver Meeting 2017: I'm A HCV Patient - Show Me What I Need To Know!

Hi folks, because this blog has always been about you, the patient, I put together a quick overview of the Liver Meeting, using easy to follow video clips, and future learning activities.

Quick Review 
Jump over to Practice Point, sit back and watch 5 minute video clips reviewing each day of the meeting. The good doctor, Mark Sulkowski, will discuss SVR results, toxicity/adverse events, drug interactions, and HCV management. Although, a free registration is required, its worth the time you'll save looking elsewhere for cure rates that either correlate with your own stage of disease or genotype.

Clinical Clips Each Day Of The Meeting - ‘What you need to know in 5-minutes’
Hosted by Mark Sulkowski, MD

I have summarized each video, followed with a link to a few study results (slides), commentary and media coverage.

Day 1
October 21  - Summary
1 - Treatment: Access in the US, active or recent drug use.
2 - Liver transplant patients HCV genotype 1-4.
3 - What happens after a patient is cured. SVR cohort of persons in clinical trials followed for up to 2.5 years.
Watch Video Clip (LINK)

Access to treatment in the United States - Medicaid and Medicare
Abstract 561 -  Disparate Access Based on Insurance Status to Highly Effective Direct Acting Antivirals (DAA) for Hepatitis C Virus Treatment in the Post-DAA Era Persists: Alarmingly Impaired Access in Medicaid Recipients

Liver transplant patients HCV genotype 1-4
Abstract 1069 - Sofosbuvir/Velpatasvir for 12 Weeks in Genotype 1-4 HCV-Infected Liver Transplant Recipients

HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

Patients Who Develop Recurrent HCV Infection Post Liver Transplantation

Day 2

October 22 - Summary
1 - Mavyret (glecaprevir/pibrentasvir) for genotype 3 patients treated for 8 and 12 weeks with and without cirrhosis; SVR and relapse rates.
2 - Mavyret in patients with genotype 1-6.
3 - Harvoni (Ledipasvir/Sofosbuvir) genotype 1 with kidney disease.
4 - Quality of life in patients achieving SVR in a long-term study.
5 - VA study, does cure matter, reduce in liver cancer, improved survival.
6 - Risk calculator, can you predict which person after SVR will develop liver cancer, calculator will soon be on VA hepatitis website.
Watch Video Clip (LINK)

(Slides) Mavyret (glecaprevir/pibrentasvir) for genotype 3 patients treated for 8 and 12 weeks
Efficacy and Safety of Glecaprevir/Pibrentasvir for 8 or 12 Weeks in Treatment-naïve Patients with Chronic HCV Genotype 3: An Integrated Phase 2/3 Analysis
Conference Coverage - NATAP

(Slides)Mavyret in patients with genotype 1-6
Efficacy, Safety, and Pharmacokinetics of Glecaprevir/Pibrentasvir in Adults With Chronic Genotype 1-6 Hepatitis C Virus Infection and Compensated Cirrhosis: An Integrated Analysis
Conference Coverage - NATAP 

(Slides) Harvoni (Ledipasvir/Sofosbuvir) genotype 1 with kidney disease 
Safety and Efficacy of Treatment With Once-Daily Ledipasvir/Sofosbuvir (90/400 mg) for 12 Weeks in Genotype 1 HCV-Infected Patients With Severe Renal Impairment 
Conference Coverage - NATAP  

Abstract 64. Significant and Sustained Improvement of Health-Related Quality of Life (HRQL) Scores in Patients with Hepatitis C (HCV) and Sustained Virologic Response (SVR)

Hepatitis C cure leads to improved quality of life
Commentary - Quality of life in patients achieving SVR in a long-term study.
Liz Highleyman
Cirrhosis, depression, anxiety and fatigue were independent predictors of lower health-related quality of life scores in a multivariate analysis. However, after adjusting for baseline levels, people with cirrhosis, depression, fatigue, insomnia and type 2 diabetes saw larger gains, suggesting that people with co-morbidities may experience the largest improvements after achieving SVR, Younossi said.
Read the article - http://ift.tt/2hd0Qsx

(Slides) VA study, does cure matter, reduce in liver cancer, improved survival
Impact of Sustained Virologic Response with Direct-Acting Antiviral Treatment on Mortality and Hepatocellular Carcinoma - significantly lower mortality, HCC 60% to 84% -

Conference Coverage - NATAP 

AASLD Press Release
The Liver Meeting® - Direct‐Acting Antiviral Therapy Cuts Liver Cancer Risk By 71%

Of Interest
Vets with HCV Might Settle Cancer Controversy
VA experience seems to rule out possible cancer-causing effect of new drugs
In the largest cohort analyzed to date -- some 62,000 patients in the VA system -- there is no evidence that therapy with newer agents that act directly against the virus (DAAs) increases the risk of hepatocellular carcinoma (HCC), according to George Ioannou, BMBCh, of the Veterans Affairs Puget Sound Health Care System in Seattle.
Read the article -  http://ift.tt/2lb3tj2

Day 3

October 23  - Summary
1 - Treatment as prevention in high risk populations, active drug use, risk for HCV infection.
2 - Opioid agonist treatment for acute, first infection or re-infection.  

Watch Video Clip (LINK)

Treatment as prevention in high risk populations - testing.

(Slides) abstract 125 - The Impact of Hepatitis C Diagnosis on Substance-Use Behaviors in Patients Engaged in Opioid Substitution Therapy - HCV screening/diagnosis reduces drug use by 33% (non-prescribed opioids, benzodiazepines and cocaine)

Conference Coverage - NATAP

Low reinfection
(Slides) - HEPATITIS C VIRUS REINFECTION AND INJECTING RISK BEHAVIOR FOLLOWING ELBASVIR/GRAZOPREVIR TREATMENT IN PARTICIPANTS ON OPIATE AGONIST THERAPY: C-EDGE CO-STAR PART B

Conference Coverage - NATAP

Opioid agonist treatment for acute, first infection or re-infection 

(Slides) - A5327 Sofosbuvir-Containing Regimens Without Interferon for Treatment of Acute HCV in HIV-1-infected Individuals (SWIFT-C)

Conference Coverage - NATAP

AASLD Press Release

The Liver Meeting® 2017 - Screening for Hepatitis C Improves Opioid Abuse Treatment Outcomes

Hepatitis C virus, commonly called HCV, is a liver disease that ultimately can cause cirrhosis (scarring of the liver), liver cancer and liver failure. HCV is mainly contracted when a person comes in contact with an infected person’s blood. One of the most common ways to contract HCV is through needle sharing to inject drugs – thus making HCV an additional concern for those working to combat the opioid epidemic.

Day 4

October 24  - Summary
1 - The development of new drugs to treat HCV ends.
2 - Getting difficult people linked to care. 
3 - Treatment adherence, Mavyret
4 - SVR rates in patients who were Non adherent (defined at less than 80%) vs adherent, more than 80%. How many pills can you miss? What were the SVR rates in both groups?
Watch Video Clip (LINK)

Linkage to care
(Slides) - Randomized Controlled Trial of Cash Incentives or Peer Mentors to Improve HCV Linkage and Treatment Among HIV/HCV Coinfected Persons Who Inject Drugs: The CHAMPS Study 
Conference Coverage - NATAP

Treatment adherence Mavyret
(Slides) - Adherence to Pangenotypic Glecaprevir/Pibrentasvir Treatment and SVR12 in HCV-infected Patients: An Integrated Analysis of the Phase 2/3 Clinical Trial Program

Manufactures discontinuing the last series of HCV drugs in development
(Slides) - C-BREEZE-2: Efficacy and Safety of a Two-Drug Direct-Acting Antiviral Agent Regimen Ruzasvir 180 mg and Uprifosbuvir 450 mg for 12 Weeks in Adults With Chronic Hepatitis C Virus Genotype 1, 2, 3, 4, 5, or 6 

(Slides) - Evaluation of the efficacy and tolerability of JNJ-4178 (AL-335, odalasvir, and simeprevir) in hepatitis C virus-infected patients without cirrhosis: The Phase IIb OMEGA-1 study 

The presentation was summed up nicely, noting that as the HCV pipeline ends, the task at hand is now testing, access to care and treatment.  

Testing
Implementation of Hepatitis C Elimination
John Ward, MD, CDC

(LINK) - Coverage At NATAP
ID Week San Diego CA October 4-8, 2017

Access To Care 

State of Hepatitis C Medicaid Access

This week, National Viral Hepatitis Roundtable (NVHR) together with The Center for Health Law & Policy Innovation of Harvard Law School (CHLPI) launched Hepatitis C: State of Medicaid, an in-depth evaluation of treatment access in each state’s Medicaid program, while highlighting successes in access expansion as well as ongoing challenges. Over half of Medicaid programs received a “D” or an “F” for imposing discriminatory restrictions on hepatitis C cures.
View an Interactive Map - Click on your state to find out - State of Hepatitis C Medicaid Access - read your states full report, this includes: Liver damage restrictions, Sobriety restrictions, Prescriber restrictions with recommendations, and download the full report: 2017 NATIONAL SUMMARY REPORT.

Opioid Epidemic
One of the most dramatic medical success stories in recent years has been the introduction of new drugs that eradicate hepatitis C virus (HCV). But it's a different story among HCV patients with substance use disorders. This population typically does not have easy access to conventional health care so it is difficult to screen, diagnose and treat these individuals.
Read the article - Solving the hepatitis C epidemic among people with substance abuse disorders

Surgeon General: We will conquer HCV, opioids ‘one bite at a time’
During a session focused on the connection between the hepatitis and opioid epidemics at The Liver Meeting 2017, Jerome M. Adams, MD, MPH, Surgeon General of the U.S., advised physicians in attendance that hepatitis C elimination will require nontraditional partnerships and innovative strategies for education, prevention and screening.

“I want to ask you all a question that I hope all of you know the answer to,” Adams said to the audience. “How do you eat an elephant? One bite at a time. If you take one bite at a time, if you help all of our partners see which part of that elephant they can take a bite of, we will be able to consume that elephant that is the opioid epidemic.”
Read article available online at Healio

HCV In The Older Patient 

(Slides) - Safety and Efficacy of 12 Weeks of Elbasvir (EBR)/Grazoprevir (GZR) in Hepatitis C Virus (HCV) GT1- and GT4-Infected Participants 65 Years and Older: An Integrated Analysis of Twelve Clinical Trials
Conference Coverage - NATAP

Great Article

HCV in the Older Patient - Natural history, extrahepatic disorders, safety and efficacy of treatment regimens

Read the article published yesterday in Infectious Diseases Clinics - http://ift.tt/2zH2LN7

HCV In Our Young People 

Hepatitis C Is Threatening Our Youth
October 23, 2017 • By Lucinda K. Porter, RN

Hepatitis C is the most common bloodborne virus in the U.S. More people die every year from hep C than all 60 reportable infectious diseases combined, including HIV. Historically, hepatitis C virus infection (HCV) was considered a baby boomer disease; a legacy that we hoped would die with us. However, we got that wrong. Today’s opioid crisis is causing a new wave of HCV infections, and is threatening our youth.
Read the article - http://ift.tt/2hcmzkA

Save The Date - Advances in Chronic Hepatitis C: Management and Treatment
Next week, ViralEd will slowly launch a series of video modules with comprehensive coverage of the meeting, hosted by a panel of leading HCV experts. On Nov 3rd: Advances in Chronic Hepatitis C: Management and Treatment, will be available for your viewing pleasure.
Begin here - http://ift.tt/2yFMfyW

Helpful Links

HCV Guidance Updates

New Treatment-Naïve & Treatment-Experienced
The following pages include guidance for management of treatment-naive patients.
Genotype 1
Genotype 2
Genotype 3
Genotype 4
Genotype 5 or 6

The following pages include guidance for management of treatment-experienced patients.

Genotype 1
Genotype 2
Genotype 3
Genotype 4
Genotype 5 or 6

Stay current with all guideline updates, "click here."

On This Blog
Get started by clicking on this (LINK) for patient-friendly coverage of the meeting, or click on the following topics:

Fibrosis

Cirrhosis

Transplant

Liver Cancer

Genotype

Hepatitis B

HIV Co-infection
Cure Rates - SVR
High‐risk behavior - Drug Use

Fatty Liver
Herbal and dietary supplements

I hope this collection of links will help make the rest of your journey a little easier.

Tina

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