Hepatitis Scotland e-Bulletin May

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


Brewing up a perfect storm? Alcohol, drugs and Hepatitis C conference


COSLA Conference Centre, Edinburgh EH12 5BH
Wednesday, 24 June, 2015    £50 per delegate

Hepatitis Scotland, in conjunction with Scottish Health Action on Alcohol Problems (SHAAP), are holding a conference that will focus on the health impact of alcohol on those who are affected by Hepatitis C and highlight current practice implications.

Speakers and topics include:
• Dr Michaël Schwarzinger, Translational Health Economics Network, Paris
• Professor David Goldberg, Glasgow Caledonian University and Health Protection Scotland
• Professor Linda Bauld, University of Stirling and Cancer Research UK
• Peer researcher presentation of alcohol and hepatitis service user survey
• Contributions from practitioners and key Scottish Government officials

This event is aimed at:
• Clinicians, workers and representatives, especially Drug and Alcohol Treatment services and specialist Hepatitis C services
• Service planners, commissioners and providers

To book please visit our events page.

You can also view our recent video discussion with Dr. Peter Rice of SHAAP discussing alcohol and Hepatitis Chere.


I tried to give up drugs by drinking


Lou Reed's death, attributed to liver failure related to hepatitis C,  highlights how alcohol abuse can complicate the hepatitis C picture. A presentation at the Liver Congress 2015 (abstract)  has suggested that alcohol misuse plays a major and often underappreciated role in the morbidity associated with chronic Hepatitis C infection and can confound cost-benefit assessments of direct acting anti-viral drugs.

The study reported that in a study of nearly 30000 French Hepatitis C patients, 86% of liver related events or in hospital deaths occurred in patients with chronic alcohol misuse disorders or severe comorbidities. In patients with chronic Hep C, alcohol withdrawal or abstinence resulted in a 29% reduction in risk of such outcomes compared with continuing to drink.

Dr. Michael Schwarzinger, presenting, said that the findings from this study suggest that the ‘expected value of interferon-free treatments in cost-effectiveness models is overestimated in patients without alcohol abuse disorders or severe comorbidities.’

Dr. Schwarzinger will speak on this subject at the Alcohol, Drugs and Hepatitis C conference.


HCV treatment cost effective in patients with moderate to severe liver disease

According to a study published in Hepatology, treating Hepatitis C in patients with moderate to severe liver disease with anti-viral therapy was cost effective if treatment was begun immediately versus delaying treatment, a common dilemma for physicians and patients.


Hep C treatment right under our noses?


study suggests an inexpensive over the counter allergy medication could be effective in treating Hepatitis C infection. Researchers have identified chlorcyclizine (CCZ), an antihistamine drug for allergy relief, as a potent inhibitor of Hepatitis C infection and is synergistic with other Hepatitis C treatments including ribavirin, interferon alpha, telaprevir, boceprevir, sofosbuvir, daclatasvir and cyclosporin A and has potential as part of a combination therapy.

Statins found to be beneficial in Hepatitis C treatment

A new study published in Hepatology has shown that statin use is significantly associated with improved response to anti-viral treatment, decreased progression of liver fibrosis and decreased incidence of hepatocellular carcinoma.


Methadone maintenance and needle exchange protect Scottish drug users from Hep C


recent study published in the International Journal for Drug Policy suggests that methadone maintenance plus an abundant supply of clean needles and syringes protects Scottish injecting drug users from Hepatitis C infection.

It found that those who had at least twice the amount of needles and syringes available than needed had a statistically significant 70% less chance of becoming recently infected with Hep C.


Gilead keeps Georgia on its mind


Gilead Sciences plans to provide free Hepatitis C treatment in Georgia to everyone who needs it in an effort to demonstrate their potential to eradicate the virus to international governments and investors. The company will offer both sofosbuvir and harvoni once it has been approved, to 5,000 patients in 2015 before treating 20,000 patients a year.

Georgia has the third highest Hepatitis C prevalence in the world behind Egypt and Mongolia, with 7% of adults infected. Gilead said that with a manageable population of 5million, combined with the fact the country has viral screening systems in place, the country is an ideal candidate to demonstrate the potential of these medications to eliminate the virus over time.

On the other hand...

The global fight against Hepatitis C is not over even with the advent of new anti-viral therapies with close to 100% cure rates according to international expert Dr. Jean-Michel Pawlotsky. Dr Pawlotsky says he does not believe that an infection present in 130-170million people can be eradicated by anti-viral therapies alone.

He said that the exorbitant pricing of drugs will work against global eradication, as well as the lack of a prophylactic vaccine – for which he says there is currently very little research under way. As such he says that the goal is to control the disease, at least in the countries that can afford to.

Benefit cuts undermine work to tackle addictions


A report by the West Dunbartonshire Alcohol and Drug Partnership, has said that benefit cuts and reforms are having a negative impact on those recovering from drug and alcohol problems.

It goes on to say, "Welfare reform changes [are] having a detrimental impact on the recovery journey of many service users, not simply affecting their financial circumstances, but also impacting on their mental and physical health and wellbeing."

Dave Liddell of the Scottish Drugs Forum said the findings were being replicated across Scotland, "An unpublished survey we did at the end of last year found that 43% of services reported a negative impact and 69% had seen an increased workload as a result of benefit reform" he said.

Most deprived get least from Hepatitis C services in England

report by IMS Health has shown that people in the lowest socio-economic groups are the victims of increasing inequality when it comes to Hepatitis C treatment and care in England. Figures covering the period of 2010-2012 show that treatment rates are higher for those in higher socio-economic groups, and that in the most deprived 10% treatment rates are actually falling. Their data also indicates that 80% of newly diagnosed patients are in the most deprived 50% of the population.

GPs attack Conservative plans to cut benefits for refusing treatment

GPs have attacked plans unveiled in the Conservative party manifesto to reduce benefits of those with treatable conditions (such as drug addiction or obesity) who refuse recommended treatment. Former RCGP chair Professor Clare Gerada, who has a special interest in addiction, said the policy would adversely affect doctor/patient relationships.

She said: ‘It would mean that GPs have to dob patients in. We will become probation officers rather than advocates for patients.

DWP forced to reveal details of benefit related deaths

England's Information Commissioner is to launch an investigation into the DWP's failure to release information on 49 deaths that campaigners allege were related to benefit sanctions.

How the 1% live

A Barclays trader who earned £150 MILLION pounds in five years of trading other people's money feels he needs more.


Beyond Penrose


Following the publication of the Penrose Report into infected blood products,representatives from the Scottish Infected Blood Forum and Haemophilia Scotland met with First Minister Nicola Sturgeon and Health Minister Shona Robison.

View the response of Haemophilia Scotland to the Penrose report here, itsrecommendations regarding the report, its response to apologies from the UK and Scottish governments and thoughts about access to IFN free medications.


New Hepatitis C video aimed at GPs/primary care providers


The Hepatitis C Trust have teamed up with HCV Action to produce a 4 part video aimed at increasing the knowledge of primary care providers of Hepatitis C.

Barriers affecting primary care providers, patients for proper treatment of HBV and HCV

A recently published research article has considered strategies needed to provide HBV and HCV  screening and treatment for immigrant groups in the UK and highlights the need to consider levels of understanding within communities, and barriers to accessing healthcare, that may affect capacity to engage with screening and treatment.


Should I stay or should I go?

Delayed Hep C treatment may increase liver deaths

Data presented at the annual Conference on Retro viruses and Opportunistic Infections suggests that delaying Hep C treatment for 1 year or more after diagnosis or until there is evidence of advanced liver disease may increase liver related mortality.

Researchers pointed out that there is some debate on whether it is safe to delay treatment for Hepatitis C until advanced liver disease and whether deferring treatment also had implications for the risk of Hepatitis C transmission.

The researchers also pointed out that, with transmission risk increasing fourfold if treatment was delayed to F4.


One more cup of coffee


new study conducted in Europe has supported extensive studies conducted in Asia that show regularly drinking coffee and tea reduces the risk of developing hepatocellular carcinoma. The European Investigation into Cancer Nutrition (EPIC) identified 201 cases of HCC in 486,799 people with a mean follow up of 11 years. It found that increased coffee and tea intakes were consistently associated with lower risk of hepatocellular carcinoma, with coffee particularly beneficial.



Hep C treatment updates

New EASL guidelines prioritise interferon free Hepatitis C treatment

New guidelines released by the European Association for the Study of the Liver have recommended prioritising interferon free treatment for Hepatitis C.

Hepatitis C medications added to list of essential medicines

5 new Hepatitis C medications have been added to the World Health Organisations List of Essential Medicines.

Simeprevir label also changed to reflect cardiac risk

The US FDA has approved a label change for Janssens’ simeprevir, trade name Olysio, to warn prescribers and patients of an increased risk of serious symptomatic bradycardia when the drug is combined with heart drug amiodrone and Hep C treatment sofosbuvir. The change also warns of an increased risk of liver decompensation and liver failure when the 3 drugs are used together.

In March, Gilead Sciences sofosbuvir and sofosbuvir/ledipasvir combination (Harvoni), also underwent FDA label changes after 9 patients experienced serious adverse events when taking the medications alongside amiodrone.

Second time lucky for Merck

The US FDA has granted ‘Breakthrough Drug’ status to Merck’s Hepatitis C treatment candidate grazoprevir/elbasvir to fast track approval for treatment of chronic Hepatitis C genotype 1 infection in end stage renal disease patients on hemodialysis and patients with chronic HCV genotype 4 infection.

Resistant variants emerging in Daclatasvir/asunaprevir treatment

Deep sequencing of daclatasvir/asunaprevir dual therapy for HCV genotype 1 has uncovered resistant variants that may contribute to viral breakthrough in some patients.

HCV treatment cost effective in patients with moderate to severe liver disease

According to a study published in Hepatology, treating Hepatitis C in patients with moderate to severe liver disease with anti-viral therapy was cost effective if treatment was begun immediately versus delaying treatment, a common dilemma for physicians and patients.

Low HCV RNA does not always mean treatment failure

small study published in Clinical Infectious Diseases has reported that patients with low levels of quantifiable HCV RNA at the end of treatment may still have had a successful response to treatment.

Anti viral treatment and extrahepatic outcomes in Hep C patients

A recent Taiwanese study has shown that anti-viral treatment for Hepatitis C is associated with improved renal and circulatory outcomes but is unrelated to catastrophic autoimmune diseases. Patients involved in the study were treated with peg Interferon and Ribavirin, but study authors say there is no reason to believe that these drugs specifically contributed to positive outcomes (new DAAs may do the same), and that in fact they are associated with multiple negative effects.

Study results promising for HCV liver transplant patients

A recent phase III trial of daclatasvir in combination with sofosbuvir and ribavirin has shown high cure rates for patients who either had recently received a liver transplant (93%) and those with advanced cirrhosis awaiting a liver transplant (83%).


Hepatitis B updates

Cancer drug possible cure for Hepatitis B?

Australian scientists may have found a cure for Hepatitis B infection, with a promising new treatment having resulted in a 100% success rate in preclinical models. The treatment – a combination of existing Hepatitis B treatment entecavir and cancer drug birinapant – is now in phase 1/2a clinical trials in Melbourne, Perth and Adelaide.

The research was published in two papers (see here and here) in journal Proceedings of the National Academy of Sciences.

Oral Hep B vaccine could become a reality

Researchers are reporting progress toward development of a radical new method of producing vaccines from genetically modified corn, an approach that could lead to an oral Hepatitis B vaccine that requires no refrigeration and costs less than $1US per dose to manufacture.

The vaccine would be able to last for years at room temperature and could be administered without medical staff. The researchers estimate that it could cost less than 10% of what current injectable vaccines cost.

Guidelines for managing Hep B reactivation

The American Gastroenterological Institute has issued new guidelines on the management of Hepatitis B reactivation. View a summary here.


Hepatitis Scotland
91 Mitchell Street
G1 3LN

Telephone: 0141 225 0419
Fax: 0141 248 6414