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Welcome to the latest Hepatitis Scotland e-Bulletin.
NHS Lothian is currently investigating a case of Hepatitis C in a patient who attended the Emergency Department at the Royal Infirmary of Edinburgh in July 2013. Investigations show that this patient is likely to have become infected through cross-contamination which occurred in the Department.
Recent approvals of new treatments means that the era of interferon free therapy is now upon us, with other interferon free treatments currently awaiting approval - e.g. e.g Bristol Myers Squibb have had Daclatasvir receive approval for an accelerated regulatory review in Europe. Ribavirin-free treatments are also close to hand. However, the picture of new Hepatitis C treatments is not a straightforward one.
In the US Sofosbuvir (Sovaldi) will cost $84,000 per patient for a 12 week course of treatment and $168,000 for a 24 week course.
This presentation by Professor Graham Foster, given at the 2013 Viral Hepatitis Congress in October, explains in simple terms what the new drugs will mean for Hepatitis C treatment - as well as looking at some potential pitfalls. Recent research published in the Hepatology journal has found that treatment of Hepatitis C with Interferon and Ribavirin reduces risk of kidney disease, heart disease and stroke in diabetic patients - with research pointing to a link between Hepatitis C infection and diabetes. You can also read a blog post by our Information and Communications Officer which looks at new treatments, decisions on when to start treatment and the dilemmas faced by both patients and practitioners in making these decisions.
GSK have moved to end the practice of paying healthcare professionals to speak on its behalf, about its products or disease areas, to audiences who can prescribe or influence prescribing. After recent problems with regard to its business practice the company has looked to be more transparent about its promotion of its products.
An Australian study published in the Journal PloS One has found has found high rates of re-infection and spontaneous clearance of re-infection among injecting drug users. The researchers suggest that patients may have acquired a partial immunity to the virus.
The study included 188 patients with HCV who had injected drugs in the past 6 months. There were 9 confirmed re-infections in 7 patients and 17 possible re-infections in 16 patients. HCV samples were genotyped and a confirmed re-infection was defined as genetically distinct from the previous infection; with a possible re-infection defined as an instance where genetic distinction could not be made.
According to researchers the time to spontaneous clearance was shorter in confirmed and possible re-infections compared with primary infection. However, it was noted that 50% of confirmed re-infections and 41% of possible re-infections did not spontaneously clear.
The researchers concluded that this has implications for our understanding of acquired natural immunity to Hepatitis C; but that the persistence of large numbers of re-infections demonstrated the need for public health campaigns to educate PWID about ongoing risk of infection after spontaneous clearance and potentially after successful antiviral treatment.
A study published in the journal Hepatology has found that female sex, the gene IL28B and HCV genotype 1 are independent predictors of spontaneous HCV clearance (undetectable levels of the virus without HCV treatment).
Researchers used data from a collaboration of 9 prospective studies from Australia, Canada, the Netherlands and the US including patients recruited between 1985 and 2010. They found a spontaneous clearance rate of 25%. They said that further research is necessary to understand the effect of sex in controlling HCV infection. Athens or institutional login required.
Another recent conference presentation showed that nearly 10% of HIV positive gay men in Europe diagnosed with Hepatitis C became re-infected after clearance, with some becoming infected a 3rd and 4th time. The researchers concluded "Spontaneous clearance rates seem to increase with reinfection episodes...Spontaneous clearance of a previous episode increases the likelihood to clear again.
Greece has set up its' first drug consumption room in Athens in response to a surge in infectious diseases among drug users since crippling austerity measures were introduced in the wake of the country's economic collapse. Cuts to needle exchange programmes saw a more than 1000% rise in HIV transmission in the early part of 2011.
The drug consumption room has been visited by more than 200 people since it opened in October and also aims to reduce fatal overdoses. The facility is run by Greece's Organisation Against Drugs (OKANA) and they say demand is increasing day after day. OKANA head, Sakis Papaconstantinou, adds, '...we believe that very soon we may need more facilities in other parts of the city'.
Since 1986, more than 90 drug consumption rooms have been set up in Switzerland, the Netherlands, Germany, Spain, Luxembourg, Norway, Canada and Australia.
Public attitudes to drug consumption rooms in Birmingham
In this short video, the Independent Consortium on Drug Consumption Rooms take to the streets to gain city resident's views on whether a drug consumption room would be a good thing. Most of the people interviewed said they thought it would be a good thing if it meant people were less exposed to blood borne viruses, less likely to overdose and less likely to dispose of injecting equipment in public spaces.
Denmark finds room for positives
Despite criticisms that drug consumption rooms promote criminality, it appears the rooms actually reduce the issue of public drug use without increasing crime and also save lives in the process.
Further to an article in our last e-bulletin, Arrowhead pharmaceuticals have submitted an application for a phase 2a trial of its' genetic Hepatitis B treatment ARC-520. The treatment was successfully tested in primates and where it substantially reduced viral DNA as well as associated antigens for more than 2 months.
Researchers also observed an 'immunological flare' which they said could lead to antigen conversion and a 'functional cure'.
This study highlights the relevance of measuring plasma RBV concentrations during and at the end of HCV treatment, with a view to avoiding virologic relapse.
Research published in the Journal of Infectious Diseases has shown that Hepatitis C can remain infectious in dried spots of blood for up to six weeks at normal room temperatures. They also found that commercially available anti septic could reduce the infectivity of blood, but only when used at recommended concentrations.
The investigators from Yale University believe that this could help explain ongoing hospital acquired HCV infections in people who have not had surgery or received blood products - as well as helping to explain the continuing Hepatitis C epidemic in injecting drug users.
Hepatitis C had previously been known to remain infectious outwith the body in minute and even invisible quantities of dried blood.
EASL Clinical Practice Guidelines: Management of hepatitis C virus infection
The European Association for the Study of the Liver has revised it's clinical practise guidelines for the management of Hepatitis C. View here.
NICE technology appraisal guidance 300: Peginterferon alfa and Ribavirin for treating chronic Hepatitis C in children and young people.
New technology appraisal guidance from the National Institute of Clinical Excellence. Read here.