Top 10 Hepatitis Stories of 2017
Every year there is always a lot of noteworthy news and information about hepatitis C (HCV), and the trend continues in 2017. What was surprising was the amount of news about hepatitis A in 2017. In this article, I will provide a brief overview of some of these newsworthy items about HCV and the outbreaks of hepatitis A around the country. For more information about these news items, you can check out our HCV Advocate News & Pipeline Blog http://hepatitisc.hcvadvocate.org.
All of the stories listed below are important. I will let you decide which story is the most important. The news story that stood out for me is the convergence of the opioid crisis and the second epidemic of HCV.
Opioid Crisis and Second HCV Epidemic
The on-going opioid crisis and the second HCV epidemic go hand-in-hand. The current opioid epidemic is the largest in U.S. history. In 2016, it killed approximately 64,000 Americans. It touches every socio-economic level of Americans -- rich/ poor, educated/uneducated, employed/unemployed, privileged/underprivileged, urban/rural, etc. It has occurred all across the United States. It is affecting adults, children, teenagers (males and females equally) and unfortunately, babies.
The opioid crisis is also fueling the second epidemic of HCV. New infections of hepatitis C in the U.S. have reached a 15-year high. The CDC estimates that there were 34,000 new infections in 2015. This reported number of new infections is likely low since national surveillance system is underfunded understaffed; as a result, acute infections are likely underreported.
Related: Hepatitis C and Health Literacy
Needle exchange services are an important way to slow down and stop the spread of hepatitis C, HIV and other communicable diseases. There are some counties and states that have embraced needle exchange. More needs to be done to stop the spread of diseases. We must also include more funding to support needle exchange and provide rehabilitative services.
Many state Medicaid systems have removed restrictions on access to HCV medications based on liver disease severity. Hopefully, in 2018 all the restrictions on disease severity will be removed. The next battle will be to drop the ridiculous restrictions about alcohol and drug sobriety.
Visit the National Viral Hepatitis State of Medicaid Access, https://stateofhepc.org to view a comprehensive report by state.
HCV-Positive Organs to HCV-Negative People
There are on-going successful organ transplants of HCV-positive kidney transplants into people who are HCV-negative. There are similar types of transplants with livers and hearts; recipients are treated for HCV post-transplant. The people who received HCV+ organs would have had to wait years or possibly die waiting for a transplant without the HCV+ organs.
DAAs and Liver Cancer
There has been a lot of controversy regarding treatment with direct-acting antiviral (DAA) medications causing liver cancer. So far, most of the evidence points to the same types of HCV progression to liver cancer after treatment as seen with interferon-based therapies:
- People with severe fibrosis or cirrhosis treated with DAAs and cured had a lower risk of developing liver cancer. Importantly: follow-up monitoring is required.
- People with no or minimal disease (no fibrosis or minimal fibrosis) treated with DAAs and cured had no further disease progression. Importantly: no further follow-up is required.
Two reports that we wrote about from the Liver Conference are in the December 2017 HCV Advocate newsletter.
New HCV Drugs Approved
Children: There were two drugs approved by the FDA to treat children ages 12 to 17 -- Harvoni and Sovaldi. The cure rates were up to and over 90%.
Adults: Vosevi and Mavyret: Two new medications were approved by the Food and Drug Administration (FDA) in 2017 to treat HCV in adults. Both drugs have cure rates approaching 100% for all genotypes. Vosevi and Mavyet are the last HCV drugs to be approved. There were two other HCV drugs in development, but the pharmaceutical companies have discontinued their development. We now have all the medications needed to cure everyone with hepatitis C. To view the Food and Drug Administration (FDA) direct-acting drugs approved to treat hepatitis C, go to http://hepatitiscmedications.hcvadvocate.org.
The costs of HCV medications are coming down. Mavyret was approved this year and came in at the lowest price of any DAA yet, and the other DAAs have been negotiated to lower price points. Still, we need even lower costs to make the medications available to everyone with HCV.
Clinical Trials: Drugs to Use in Pregnancy
Finally, studies are being conducted to find out if the current direct-acting antiviral medications can be safely given to pregnant women to prevent motherto- child transmission of hepatitis C. To view clinical trial information, go to our Clinical Trial Reference Blog http://hcvclinical.hcvadvocate.org and www.clinicaltrials.gov.
The goal to eliminate HCV is falling short in the United States and worldwide except for the Veterans Administration, which is on track to eliminate HCV. Hurrah for the VA and our veterans!
Another bold project is the plan to screen all tribal citizens of the Cherokee Nation health centers. Those Cherokee citizens who test positive for HCV will be treated for hepatitis C.
Some cities and states (examples are San Francisco and New York City) set goals to eliminate HCV. They have very effective strategies in place.
Although not HCV-related, an important story this year were the outbreaks of hepatitis A. There were outbreaks all over the country, but one of the major outbreaks occurred in San Diego County. As of the beginning of December, there were 567 reported cases, 20 deaths and 382 hospitalizations. Hepatitis A is usually not this deadly, but this outbreak predominately affected the homeless population. The homeless are a very vulnerable people who are at-risk the most severe consequence of hepatitis A. The reasons are many -- compromised immune systems, limited access to healthcare and sanitary services, a nd living on the streets -- just to name a few.
How could the HAV outbreak in San Diego County and elsewhere be prevented? The easy answer is prevention -- hepatitis A vaccination. The other preventive strategy that should have been put into place as soon as the outbreak started was massive hepatitis A vaccination of the homeless population. One reason the outbreak occurred was due to lack of plastic bags because of the new California law banning the plastic bags. The law was good for the environment, but the homeless population used the bags to clean up their waste (poop). There are biodegradable bags available but were not handed out to the homeless. Something so simple was one of the reasons for the outbreak.
While I'm on my soapbox and none of this is a blame game -- there are also many outbreaks of hepatitis A transmitted from food service workers. These outbreaks occur all over the country. Why don't we require hepatitis A vaccination of food service workers? They do this in Las Vegas, and we should be vaccinating every population that has the potential to transmit to the public.
[Note from TheBodyPRO.com: This article was originally published by HCV Advocate in Jan., 2017. We have cross-posted it with their permission.]