HepCInfo Update 3.9 for April 21st – May 4th, 2012
Welcome to HepCInfo Update 3.9 for April 21 – May 4, 2012. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.
New and newsworthy
Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: Do safer smoking kits have a potential role to play?
Many negative health effects, including potential hepatitis transmission, are associated with smoking crystal methamphetamine. In a new Canadian study published in the Harm Reduction Journal, the authors set out to determine whether a crystal methamphetamine smoking kit might help reduce the negative health effects of this practice.
Pipe sharing, which was widespread among study participants, was viewed as an integral part of the social experience of smoking crystal methamphetamine. Because of this, “changing pipe sharing behaviors may be difficult,” the researchers concluded. Though heated pipes were unlikely to cause direct injuries, many smokers reported having dry, cracked lips, “which may be a vector for disease transmission.” Many smokers reported sex with multiple partners and being less likely to use condoms while taking the drug. There was mixed demand for harm-reduction kits.
“Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities (e.g., homeless/street-involved youth) is worth pursuing.” (US Centers for Disease Control, May 2012, in English)
Prison puzzle: Treating hepatitis C
According to figures obtained by CMAJ through a federal freedom of information request, Correctional Services of Canada’s (CSC) bill for hepatitis drug treatment was $4.7-million in 2010, roughly 4% of the agency’s health budget for inmates and an almost sevenfold increase since 2005. Demand for treatment continues to skyrocket and is beyond CSC’s current capacity.
Compounding the problem is the absence of harm reduction programs in prison. CSC’s “rejection of strategies such as needle exchange and safer tattooing programs in prisons is a well-known public health menace,” says Dr. Peter Ford, an Ontario-based physician who oversees HIV and hepatitis treatment in federal prisons. (Canadian Medical Association Journal News, May 2012, in English)
FDA Drug Safety Communication: Updated information on drug interactions between boceprevir (Victrelis) and certain boosted HIV protease inhibitor drugs
The U.S. Food and Drug Administration (FDA) is notifying the public that co-administration of the hepatitis C virus protease inhibitor boceprevir (Victrelis) along with certain ritonavir-boosted HIV protease inhibitors is not recommended at this time. This is because of the possibility of reducing the effectiveness of the medications. Ritonavir-boosted HIV protease inhibitors include ritonavir-boosted atanavir (Reyataz), ritonavir-boosted darunavir (Prezista), and lopinavir/ritonavir (Kaletra).
People should not stop taking any of their hepatitis C or HIV medicines without talking to their healthcare professional.
This announcement is an update to a Drug Safety Communication published in February 2012: Important drug interactions between Victrelis (boceprevir) and ritonavir-boosted human immunodeficiency virus (HIV) protease inhibitor drugs. (US Food and Drug Administration, May 2012, in English)
Telaprevir and boceprevir show high rate of serious side effects in hepatitis C patients with urgent need of treatment
A real-world study of new hepatitis C protease inhibitors in people with cirrhosis has shown a much higher rate of serious adverse events and treatment discontinuations than in clinical trials, Dr. Christophe Hézode reported at the 2012 International Liver Congress in Barcelona. Dr. Hézode presented on behalf of the French Compassionate Use of Protease Inhibitors in Cirrhotics cohort study.
Nonetheless, virologic response rates were high: up to 86% of cohort participants had undetectable hepatitis C viral load after 16 weeks of treatment. “These data strongly suggest that triple therapy must be administered cautiously with intensive safety monitoring inpatients [with cirrhosis],” conclude the investigators. (AIDSmap, May 2012, in English)
Straight to the source for new science
Tangible resources for preparing patients for antiviral therapy for chronic hepatitis C – Digestive Disease Sciences, April 2012, in English
Time to rethink antiviral treatment for hepatitis C in patients with coexisting mental health/substance abuse issues – Digestive Disease Sciences, April 2012, in English
Bipolar patients can safely and successfully receive interferon-based hepatitis C antiviral treatment – European Journal of Gastroenterology and Hepatology, May 2012, in English
The more you look, the more you find: Effects of hepatitis C virus testing interval on re-infection incidence and clearance and implications for future vaccine study design – Journal of Infectious Diseases, May 2012, in English
HIV-HCV co-infection facing HCV protease inhibitor licensing: implications for clinicians – Liver International, April 2012, in English
