Welcome to HCV Advocate’s hepatitis blog. The intent of this blog is to keep our website audience up-to-date on information about hepatitis and to answer some of our web site and training audience questions. People are encouraged to submit questions and post comments.

For more information on how to use this blog
, the HCV drug pipeline, and for more information on HCV clinical trials click here

Be sure to check out our other blogs: The HBV Advocate Blog and Hepatitis & Tattoos.

Alan Franciscus
Editor-in-Chief
HCV Advocate

Friday, September 4, 2015

D.C. Needle Policy Change Led to Massive HIV Infection Decline in 2 Years

Syringe exchange programs for injection drug users have proved successful at decreasing rates of needle sharing without increasing rates of illegal drug use. But for years, a policy shortcoming made Washington, D.C., the only city in the country that could not fund them. Caught between federal and local jurisdiction, the District has long faced issues regarding its autonomy. And according to research published Thursday, those policy issues can cost lives.

In 1998, the federal government banned the use of federal funding for syringe exchange programs. State and local governments could fund them, but the District could not. In 2007, the federal government altered that policy, and the District's municipal government began funding programs in 2008.

In a new study in the journal AIDS and Behavior, researchers used mathematical modeling to calculate how many HIV infections the policy change prevented and how much money it saved. The researchers found that in the two years after the municipal money started flowing following the policy change, there were 176 new HIV cases reported in the District involving injection drug use. Without that policy change, the researchers estimated, the number would have been 296 cases. The policy change had helped avert 120 cases.

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First-ever World Hepatitis Summit calls for national programmes-- Follows rise in hepatitis deaths for fifth consecutive year

The first World Hepatitis Summit is being held this week in Glasgow to urge countries to develop national programmes to help eliminate viral hepatitis.

Deaths from the disease have increased for a fifth year running and there are currently 400 million people living with the condition as it now claims an estimated 1.45 million lives each year, making it one of the world's leading causes of death.

Policymakers and stakeholders at the three-day meeting will discuss the World Health Organization's (WHO) Global Health Sector Strategy on Viral Hepatitis, which sets targets for 2030.

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Free Helpline and App for Hepatitis C Patients Offer Peer Support and Self-Care Tools

Viral hepatitis is known as the silent epidemic, because it is a disease that is both under-recognized and underdiagnosed. Hepatitis can result from infection with several different viruses, including hepatitis C virus (HCV). The Centers for Disease Control and Prevention estimates that nearly 3.2 million people are chronically infected with HCV and that nearly half are unaware of their infection. Untreated, hepatitis C infection can lead to liver cancer and death; yet, we have more tools than ever before to respond successfully to this epidemic. The availability of expanded coverage for preventive screening for hepatitis C under the Affordable Care Act and new therapies with cure rates over 90% are galvanizing consumer and provider awareness of this important public health issue.
One of the four goals of the national Viral Hepatitis Action Plan seeks to improve HCV testing and linkage to care for the estimated millions of Americans who are living with undiagnosed hepatitis C. The plan also seeks to ensure that individuals, who have been previously diagnosed with HCV— but are not in care— take steps to prevent damage from chronic, untreated HCV infection

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Thursday, September 3, 2015

Can vaccination contribute to hepatitis C elimination efforts? A Q+A with Nick Scott

In a recent research article published in BMC Medicine, Nick Scott and colleagues used a mathematical modeling approach to show that vaccination is likely to play a role in reducing hepatitis C prevalence. Here, Dr Scott answers our questions about the study, and explores whether vaccination could help to eliminate the infection.

Nick Scott is an Econometrician at the Burnet Institute in Melbourne, Australia. Since completing his mathematics PhD in 2012, he has been modelling infectious disease transmission among vulnerable populations to inform public health policy.

In most developed settings, new HCV infections and HCV-related liver disease occur among largely disjoint populations. New HCV infections primarily occur among people who inject drugs (PWID) through the sharing of injecting paraphernalia, but the slow progression to liver disease means that the burden of disease is increasingly occurring in an aging population.

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Repurposing of the antihistamine chlorcyclizine and related compounds for treatment of hepatitis C virus infection—S He et al.—Alan Franciscus, Editor-in-Chief

Source:  Sci Transl Med. 2015 Apr 8;7(282):282ra49. doi: 10.1126/scitranslmed.3010286

Results and Conclusions
The article discussed how a common and cheap generic antihistamine drug—chlorcylclizine HCL—could be used to treat hepatitis C.  In cell studies it was found that cholorcyclizine had antiviral effects against the hepatitis C virus.  The antiviral effect was also synergistic with other hepatitis C drugs including telaprevir, boceprevir, sofosbuvir, daclatasvir, and cyclosporine and importantly without any toxic effect to cells.    

The Bottom Line
There have been many medications that have been developed to treat certain conditions, some of their properties, and even some of the side effects help with other conditions.  An example would be mirtazapine.  It is approved to treat major depressive disorder, but one of the side effects is sleepiness.  It was found that when taken in small doses in the evening that it helped to treat insomnia.  Another example is propranolol that is approved to treat high blood pressure.  Taken at a lower dose, off-label, it reduced anxiety in people who suffer from stage fright and other anxieties such as fear of public speaking.

Editorial Comment
It is way too early to tell if chlorcyclizine will be an effective therapy to treat hepatitis C. Chlorcylclizine with and without ribavirin is currently in a phase 1 clinical trial to treat hepatitis C. There is more information available about chlorcyclizine’s clinical trial information at www.clinicaltrial.gov. Type in “chlorcylclizine” or the trial identifier NCT02118012

It is being conducted by the National Institutes of Health Clinical Center.

Wednesday, September 2, 2015

World Hepatitis Summit harnesses global momentum to eliminate viral hepatitis

2 SEPTEMBER 2015 ¦ GLASGOW - Participants at the first-ever World Hepatitis Summit will urge countries to develop national programmes that can ultimately eliminate viral hepatitis as a problem of public health concern.

“We know how to prevent viral hepatitis, we have a safe and effective vaccine for hepatitis B, and we now have medicines that can cure people with hepatitis C and control hepatitis B infection,” said Dr Gottfried Hirnschall, Director of the WHO’s Global Hepatitis Programme. “Yet access to diagnosis and treatment is still lacking or inaccessible in many parts of the world. This summit is a wake-up call to build momentum to prevent, diagnose, treat - and eventually eliminate viral hepatitis as a public health problem.”

Around 400 million people are currently living with viral hepatitis, and the disease claims an estimated 1.45 million lives each year, making it one of the world’s leading causes of death. Hepatitis B and C together cause approximately 80% of all liver cancer deaths, yet most people living with chronic viral hepatitis are unaware of their infection.

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Tuesday, September 1, 2015

Attention: If you know of people who are suing or if you are suing, please contact me at alanfranciscus@hcvadvocate.org

There are many insurance companies that are denying coverage of HCV medications to only the sickest of patients. I am working on a brief article describing why people are filing lawsuits against these insurance companies. It will be a brief overview, and I will not be using names. I am looking for quotes from people who are suing or are thinking of suing insurance companies. For example, one person told me that to be turned down for the HCV medications wasn’t medically ethical or morally just and from a monetary standpoint they were angry because they had been paying their medical premiums their entire life. Now when they needed their insurance, the company bailed on them.