Preemptive pan-genotypic direct-acting antiviral therapy in donor HCV-positive to recipient HCVânegative cardiac transplantation
Underutilized Resource? Many HCV-positive hearts are being discarded in the United States despite an unmet need for donor hearts. The aim of this study was to determine whether a preemptive antiviral treatment strategy would allow for transplanting HCV-infected donor hearts without infecting the recipient.
Preemptive + Post-transplant Therapy. The study enrolled 25 HCVânegative patients on cardiac transplantation wait list. Those offered an HCV-positive donor heart were started on preemptive DAA therapy and completed 8 weeks of DAA therapy after transplant.
Cardiac Allograft & Patient Survival 100%. Post-transplant outcomes have been excellent for the 16 patients treated with this strategy to date. In a press release, researcher Emily D. Bethea, MD, of Massachusetts General Hospital in Boston, said “With the rising number of HCV-positive donor organs, there is a time-sensitive and critical need to document both efficacy and detailed implementation strategies surrounding the successful use of HCV-positive organs.” (Read comments on the study by liver expert Jordan Feld, MD, MPH)
Hepatitis C virus risk-based vs universal screening among pregnant women: implementation and cost-effectiveness analysis
Is Risk-based Screening Enough? Researchers with Norton Healthcare and the University of Louisville in Kentucky sought to determine the impact of implementing universal HCV screening for pregnant women at Norton Healthcare. They looked at how this change impacted testing practices, and performed an analysis to determine whether or not universal screening was cost effective.
Risk-based vs Universal Screening: What Cost? Data collected on pregnant women aged 13-52 years. A restrospective analysis was performed for patients screened between May 2014 and December 2015; a prospecive analysis was performed of patinents screened between May 2016 and December 2017. Universal screening was analyzed for cost effectiveness.
Cost Increase per Patient ~$300. Universal screening was associated with a statistically significant increased likelihood of a confirmatory RNA and confirmation of active infection.
Screen, Screen, Screen. “Based on our study’s findings, we hope institutions setting policies for HCV screening will quickly adopt the best practice of auto-reflexing all HCV antibody-detected screens to a quantitative PCR test,” said researcher Michelle Rose, MBA, infectious disease manager, Population Health, for Norton Healthcare, in a press release. “Doing so will allow providers to quickly identify active, chronic HCV infection, and subsequently link these patients to care or a cure.” (Read comments on the study by liver expert Jordan Feld, MD, MPH)
High SVR in PWID with HCV despite imperfect medication adherence: data from the ANCHOR Study
PWID: Missed Opportunity for HCV Treatment? People who inject drugs (PWID) are at high risk of acquiring and transmitting HCV, yet many are excluded from HCV treatment due to concerns that their treatment adherence will be low. The goal of the ANCHOR study was to evaluate the effectiveness of HCV treatment in PWID with chronic HCV.
~90% PWID Patients Achieved SVR. Approximately 90% (89.7%) of the 58 patients who attended follow-up office visit at 24 weeks achieved sustained virologic response; SVR was signifincatly associated with HCV viral load <200 at week 4 (P = 0.004) and taking 12 wks of DAA treatment (P = 0.003).
Preliminary Support for Equal Access to HCV Treatment. These preliminary findings demonstrate that people who inject drugs can achieve SVR at comparable rates to non-drug using populations, even if adherence is imperfect, according to study co-author Elana Rosenthal, MD, of the University of Maryland. Based on that, she noted in a press release, “There is no justification for excluding people who inject drugs from being treated. In fact, people who inject drugs should represent a unique high-priority population, because injection drug use remains the primary reason for ongoing HCV transmission in the United States.” (Read comments on the study by liver expert Jordan Feld, MD, MPH)
Following are highlights from 3 important studies presented at The Liver Meeting® 2018, held Nov. 9-13 in San Francisco by the American Association for the Study of Liver Diseases (AASLD). The studies cover key current issues surrounding hepatitis C screening and treatment. Investigators reported that: Universal (vs risk-based) screening of pregnant women at risk for HCV infection is a more efficient and cost-effective diagnostic approach Injection drug users who are infected with HCV have high rates of treatment adherence and relatively high rates of sustained virologic response In HCV-negative cardiac transplant patients who receive HCV-infected donor hearts, pre-emptive treatment with DAA therapy prevents chronic HCV infectionAll The Liver Meeting 2018 abstracts are published in the Oct 1 2018 issue of Hepatology.
