e-Bulletin 17


Welcome to the latest edition of the Hepatitis Scotland e-Bulletin.


The Hepatitis Scotland e-bulletin can be an opportunity to share news, views, knowledge and experience throughout our national and sector wide contact list. 


This edition features various updates in the field of viral hepatitis, including updates on treatment trials and updates on support services in your area. Keep an eye out for our themed Christmas edition which will once again be accompanied by a live web eduction seminar broadcast.


 If you have any research, ideas, news or upcoming events that you would like to see featured in our e-Bulletin, please forward the details to david@hepatitisscotland.org.uk  for consideration.


Good News on Hep C Treatments - For Now...


The last two months have seen various promising developments in the area of new, and particularly all oral, hepatitis C treatments not requiring the use of Interferon.  Achillon Pharmaceuticals, Boeringher Ingeheim, Abbott Laboratories, Medivir ABMerck, Vertex Pharmaceuticals and Gilead Sciences have all recently announced promising hepatitis C drug trial results – with high cure rates. (To view trial results click on the company name.) Gilead's sofosbuvir and daclatasvir combination therapy cured between 98 and 100 percent of patients within 12 weeks and is being touted as a 'best in class medication'.


These encouraging results are particularly important given a recent trial which suggested the new generation of protease inhibitors requiring double or triple daily dosing, was not proving attractive enough to entice people onto treatment - with many preferring to wait for all oral, interferon free treatments.


However, along with Bristol Meyers Squibb (reported in our last bulletin), Biocryst Pharmaceuticals have also been forced to suspend trials of a new hepatitis C drug due to safety concerns.  The large number of positive trial results are certainly cause for optimism in the search for an all oral, interferon free regimen for treatment of hepatitis C, but that optimism must be tempered in the knowledge that previously promising trials like that of Bristol Meyers Squibb have subsequently been suspended due to serious safety concerns.


In Other Treatment News


Australian drug company Biotron has begun phase II trials of a new drug which will treat patients with HIV/HCV co-infection.  Patients will be HCV treatment naive but will have been on HIV ART drugs with their HIV levels undetectable.  They will be treated with the new drug, BIT225 for 28 days along with HCV combination therapy of PEG-Interferon and Ribavirin, continuing to receive INF/RBV therapy for up to 48 weeks in total.


While the treatment has been shown to act on both viruses, the focus of this trial is the effectiveness against HCV, which can be a more serious virus in those with HIV.  In the UK 9% of those infected with HIV are also hepatitis C positive.


Top Marks for Tests 

A study published in the Annals of Internal Medicine in October has demonstrated that Point of Care Tests (POCTs) have a high level of accuracy and could increase screening rates for Hepatitis C.  The study was able to determine that POCTs and Rapid Diagnostic Tests (RDTs) in oral fluids and blood ranged in accuracy from 97 to 99%.


Shushmita Shivkumar MSc, from McGill University in Montreal Canada who led the study, said "Although both diagnostic test types are rapid, RDTs require special equipment, such as centrifuges and refrigerators, whereas POCTs eliminate the need for electricity and are more robust at high temperatures, thus offering additional opportunities to expand screening."


POCTs and RDT's were both found not only to have rapid turnaround times but also to be just as reliable as laboratory tests.


NEX and Harm Reduction News

 Harm Reduction Measures and Blood Borne Viruses


A study published in the British Medical Journal in October has shown that opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs.  12 published studies that examined the impact of opiate substitution treatment were included as well unpublished data from 3 other studies.  All of them examined methadone maintenance treatment. The study found no evidence that methadone detoxification is associated with a reduction in the risk of HIV transmission, along with weak evidence suggesting that greater benefit might be associated with longer measured duration of opiate substitution treatment.


This study co-incides with 2 recent reports by the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) on HIV outbreaks in Romania and Greece (covered in e-bulletin 10) at the end of 2011. 


 The Greek report states that in 2011, Greece reported a 'significant increase in the HIV case reports and the HIV prevalence among IDUs, a trend which continued also throughout the first 8 months of 2012.'

In 2012, IDU's have become the most affected population, representing 41% of all reported HIV cases.  The report cites decreases in funding for harm reduction programmes such as needle exchange and opiate substitution therapy, as well as changing patterns of injection (often linked to economic crises) amongst the reasons behind this rise. The report also notes a rise in incidence of HCV.


The Romanian report shows that compared with 14 cases of HIV transmission due to injecting drug use, this jumped to 129 cases in 2011 and has remained high at 102 so far in 2012, despite harm reduction initiatives implemented after the 2011 figures were released.  Again the report cites a significant reduction in harm reduction funding and changing injecting practises as among the leading reasons for these increases.


Swiss HIV Cohort Study


Sexually transmitted infection of hepatitis C among gay and bi-sexual men has increased markedly in the Swiss HIV cohort study, whilst remaining stable in the heterosexual population and actually decreasing among injecting drug users. With HCV infection incidence increased 18 fold in MSM the study author said, "These observations underscore the need for improved HCV surveillance and prevention among HIV-infected MSM."


In their study they attributed the decrease in incidence among IDU's to "the considerable success of preventive interventions such as methadone substitution and needle exchange programs, as well as Switzerland's long-term heroin prescription program."


Read the full study here.


Needle Exchange in Prisons


Also in October, 4 AIDS groups and a former inmate in Canada have filed a Federal Lawsuit seeking a court order that would force Ottawa to establish a needle exchange programs in Canadian prisons.  They argue that Canada should take a pragmatic, health first approach to this issue to reduce harm to prison staff, to prisoners and to the general public, recognising that 'there never has been and never will be' such a thing as a drug free prison - rendering a zero tolerance approach to the issue of drugs, and by implication harm reduction measures in prisons redundant.


The AIDS groups make the point that prisoners are not prisoners forever - with 90% returning to the community, too often with deadly baggage like HIV/AIDS and hepatitis C - raising the issue of health care equality for prisoners and the human rights implications therein.


Reacting to the lawsuit, Public Security Minister Vic Toews re-enforced that position saying, "Our government has a zero tolerance policy for drugs in our institutions."


Needle exchange services have recently been introduced in prisons in some areas of Australia.  A letter from Jonathan Brett of St Vincent's Hospital, Sydney, and published in September's British Medical Journal said that this development had been a huge step forward, and asks why the UK has yet to follow suit.


 He extols the virtues of community needle exchange programmes as a harm reduction measure, but says the rationale for needle exchange in prisons is also clear. He cites a UK report which found that 69 - 75% of prisoners who had injected drugs in prisons had shared needles. He says that 'a review of prison needle exchange programmes published in 2003 shows that they are feasible, reduce risky behaviour, and the transmission of blood borne infection and have no unintended negative consequences'.  He also points out that fears of needles being used as weapons appear unfounded.


The letter also highlights a 2011 best practise guide published by the National AIDS Trust which demonstrates the benefits of prison needle exchange programmes.


For greater background on the associated problems with drug use in prisons in Europe, the European Monitoring Centre for Drugs and Drug Addiction have just published a report titled 'Prisons and Drugs in Europe: The Problems and Responses', which you can read here.


Hep B Vaccine has Potential to Clear Infection in the Liver

Inovio Pharmaceuticals this month published results from a pre-clinical study into its' synthetic and therapeutic hepatitis B vaccine in the journal Cancer Gene Therapy.  The vaccine generated strong T-Cell responses that eliminated targeted liver cells in mice, indicating the potential to clear hepatitis B infection and prevent liver cancer. This is particularly encouraging given that it is estimated that one third of the world's population is infected with hepatitis B, with 400 million people at risk of developing liver cancer.


You can access the full study by following this link.  (Athens or professional login required)


Statins and Stem Cells in HBV Treatment

 Statins as Prevention of Liver Cancer


A meta analysis published in the journal Gastroenterology in October has suggested that Statins could be the first preventive treatment for liver cancer. It showed that statins may reduce the risk of hepatocellular carcinoma (HCC). The authors found the effect to be strongest among men of East Asian origin with HBV related cirrhosis, suggesting that these drugs could be used in chemoprevention in this population.


The study found that the risk of developing HCC was 41% lower among patients who took statins compared with those who did not. However, when the results were analysed by location, a 48% reduction was found among Asian men versus a 33% reduction in risk for Western men.


View the study here. Registration required.


Stem Cells could be Safe Alternative to Liver Transplantation

A new study from Beijing published in the October edition of Stem Cells Translational Medicine has posited that stem cell transfusions may someday replace the need for transplants in patients with liver failure caused by hepatitis B.  Patients who were treated with stem cell transfusions in this study showed increased survival rates, improved liver function and increased platelet counts.  Lead author of the study Dr. Fu-Sheng Wang, said that mesenchymal stem cell transfusion may be a good and safe alternative to liver transplantation in patients with liver failure caused by hepatitis B and that this could combat problems such as lack of available donor organs, high cost and multiple complications.


HBV: Hepatitis B Victory?

A newborn Hepatitis B vaccination program in Australia first introduced for Aboriginal babies in the Northern territory, has made significant progress in helping to eradicate chronic hepatitis B.

Researchers from UNSW's Kirby Institute and the Northern Territory's Department of Health have published a study in the international journal Vaccine that shows rates of infection are 80 per cent lower in young Aboriginal women born since the program began in 1988, compared to those born before the program began.


Researchers expect similar reductions to be seen in other parts of Australia once children vaccinated from 2000 onwards become old enough to be included in hepatitis B testing programs.


This follows similar nationwide/large scale infant vaccination success stories in both Taiwan and Cuba mentioned in previous e-bulletins. Since 1984 Taiwan has reduced the HBV carrier rate in children under 15 from 20% to 1%, whilst in June the Cuban government announced that they had all but eradicated acute hepatitis B in children under age 15 due to a nationwide vaccination programme begun in 1992 - with cases having dropped by 99% in that time from 2,194 cases in 1989 to just 21 in 2011.


Don't forget your flu jab!


If you suffer from a chronic condition such as hepatitis B or C, you are entitled to a free winter flu jab from the NHS.  You should contact your GP to arrange an appointment as soon as you can and take advantage of this service.


For more information on who qualifies for a flu jab visit the NHS flu vaccination website.


Caution on Caffeine


In our 4th e-Bulletin we published a story sourced from hepmag.com regarding possible benefits of drinking coffee on hepatitis C treatment success, which also suggested that drinking 3 or more cups of coffee a day could reduce the incidence of negative side effects whilst on treatment.


This month however, the New York Times cited a note of caution on highly caffeinated energy drinks.  Federal Officials in the United States have received reports of 13 deaths over the last 4 years linked to a highly caffeinated energy shot called 5 Hour Energy.  This was in addition to five October fatalities linked to the energy drink Monster Energy. The companies involved have said that their energy drinks are safe when used as directed.


The Substance Abuse and Mental Health Services Administration reported late last year that over 13,000 emergency hospital admissions in 2009 were associated with energy drinks alone. 


Sourced from the New York Times. Read full article here.


Vitamin D for co-infection with HCV/HIV


A new study has added further weight to the case for vitamin D supplementation in the treatment of hepatitis C, in this case HCV/HIV co-infection.  In difficult to treat patients with multiple established risk factors, low vitamin D levels were clearly associated with lower SVR rates, impairing virologic response to PEGINF-RBV combination therapy.


View study abstract here.


Hepatitis Scotland
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