​

The New York State Department of Health (NYSDOH) is pleased to share the evaluation report for the NYS Hepatitis C Testing Law.  The law mirrors the Centers for Disease Control and Prevention (CDC)’s expanded HCV screening recommendations, which were issued in 2012 and called for offering a one-time HCV screening test to “baby boomers” born between 1945 and 1965. If the screening test is positive, the law requires the provision of follow-up health care, including an HCV diagnostic test.  The law was enacted to increase HCV testing, and ensure timely diagnosis and linkage to care.
 
To determine the impact of the law, the NYSDOH drew from multiple data sources that assessed testing levels in New York before and after the law went into effect. The data included a survey of laboratories reporting HCV screening test volume data, Medicaid data, HCV surveillance data, a sample of electronic health records from care providers serving underserved communities in New York City, self-reported data from statewide population surveys, and surveys of medical providers.
 
Overall, marked increases were observed in the number of HCV screening tests and screening rates in the first year following the enactment of the HCV testing law. These increases were consistent with the expected impact of the law on testing volume and testing rates, and these observations were corroborated using multiple data sources. Increases were observed almost immediately after enactment of the law and remained steady over time at levels much higher than the years before. Smaller increases were noted in the number of people who accessed HCV care following a positive HCV screening test component.
 
Key findings from the various evaluation components can be found: 
http://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/docs/hcv_testing_law_evaluation.pdf
​
 

Most baby boomers infected in hospital and by reused medical syringes, not injecting drug use or risky sex

​Michael Carter
Published: 04 April 2016


The spread of hepatitis C virus (HCV) in North America peaked between 1940 and 1965, according to research published in Lancet Infectious Diseases. The investigators attribute the rapid spread of the infection to hospital transmissions and reuse of medical injecting equipment rather than risky behaviours such as injecting drugs, unsafe tattooing and unprotected sex.
“Based on our results, the oldest members of the demographic cohort with the highest burden of hepatitis C virus (the baby boomers) were roughly five years of age around the peak of the spreads of genotype 1a in North America in 1950,” comment the authors. “Thus, it is unlikely that past sporadic risky behaviour (experimentation with injecting drug use, unsafe tattooing, high risk sex, travel to endemic areas) was the dominant route of transmission in this group.” The researchers hope their findings will help de-stigmatise HCV infection in the baby boomer generation and encourage more patients to access testing and potentially life-saving treatment.
Up to 6 million individuals in North America are infected with HCV. Approximately three-quarters of these infections involve patients born between 1945 and 1965, the baby boomer generation. Previous studies have identified infected blood products and experimentation with injecting drug use as the main factors driving the spread of HCV in this age group.
However, how and when HCV reached such high prevalence in the 1945-65 birth cohort remains unclear. A team of investigators therefore analysed 45,316 sequences of HCV genotype 1a – by far the most common HCV strain in North America. Using a technique called phylogenetic analysis they focused on five HCV genes to reconstruct the dynamics of the HCV epidemic in North America.
Analysis of all five gene regions suggested that the greatest expansion of the epidemic occurred between 1940 and 1965. The massive growth of the epidemic had subsided by 1965 and plateaued between 1965 and 1989. There was a drop in the number of new infections in the 1990s followed by a modest increase from 2000.

TO CONTINUE STORY:    http://www.aidsmap.com/page/3047870/?utm_source=NAM-Email-Promotion&utm_medium=aidsmap-news&utm_campaign=aidsmap-news

Younossi ZM, et al. Am J Gastroenterol. 2016;doi:10.1038/ajg.2016.99.
March 31, 2016

• Patients with hepatitis C virus infection treated with interferon- and ribavirin-free antiviral regimens achieved increased quality of life during treatment compared with patients treated with interferon and ribavirin, according to published findings.


• “These findings have important implications for patients, their families, their providers and the policy makers to support the comprehensive advantage of these regiments for patients with [chronic HCV] infection,” Zobair M. Younossi, MD, MPH, chairman of the department of medicine, Inova Fairfax Hospital, and vice president for research at Inova Health System, and colleagues wrote.

Using validated patient-reported outcome instruments, the researchers evaluated the impact of different antiviral regimens for HCV on patients’ work productivity, fatigue and other outcomes among a cohort of 3,425 patients previously treated with Sovaldi (sofosbuvir, Gilead Sciences) or Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) with and without interferon or ribavirin.
Most patients (72.9%) had HCV genotype 1, 62.8% were men, 62.2% were treatment-naive and 18.1% had cirrhosis. A total of 546 received a regimen of sofosbuvir plus interferon and ribavirin, 1,721 received sofosbuvir plus ribavirin and 1,158 received ledipasvir/sofosbuvir without interferon or ribavirin.
At baseline, there were no differences in patient-reported outcomes between the treatment groups (P > .01 for all). Throughout treatment, patient-reported outcomes worsened by 23.6% for patients treated with interferon and ribavirin, and worsened by 7% in the for patients treated with sofosbuvir and ribavirin (P< .0001 for all). However, there was an 11.6% improvement in patient-reported outcomes for those who did not receive interferon or ribavirin (P < .0001).
Multivariate analysis showed interferon use was independently associated with worsening of patient-reported outcome scores up to 26% during treatment and ribavirin use was associated with worsening up to 9%.
Among patients who achieved sustained virologic response 12 weeks post-treatment, improvements in patient-report outcomes were observed regardless of what regimen they received. These improvements increased after 24 weeks of follow-up, according to the research.

“This analysis of a large amount of extensive [patient-reported outcome] primary data from patients with [chronic HCV] who were treated with different HCV regimens clearly shows the superiority of [interferon]-free and [ribavirin]-free regimens,” the researchers concluded. “The data also show the durability of the [patient-reported outcomes] benefits associated with HCV cure.” – by Melinda Stevens

http://www.healio.com/hepatology/hepatitis-c/news/online/%7B29164a55-e1d9-403c-815e-68e5e24074b7%7D/interferon--and-ribavirin-free-antiviral-hcv-r

Disclosure: Younossi is a consultant for AbbVie, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline and Intercept Pharmaceuticals.

• ​