Welcome to HepCInfo Update 3.1 for January 1 – 13, 2012. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

France: Is more frequent monitoring for liver cancer among co-infected people needed?

Crack pipe distribution pilot project in Vancouver

Health authority weighs adding more supervised injection sites

Researchers identify liver cancer risk factors

CDC reminder: Insulin pens are not for use on more than one person

An integrated alcohol abuse and medical treatment model for patients with hepatitis C – Digestive Diseases and Sciences, December 2011, in English

Help-seeking and coping with the psychosocial burden of chronic hepatitis C: A qualitative study of patient, hepatologist, and counsellor perspectives – International Journal of Nursing Studies, January 2012, in English

Neurocognitive Effects of HIV, Hepatitis C, and Substance Use History – Journal of the International Neuropsychological Society, January 2012, in English

HepCInfo Updates are also available to view online.

To subscribe and receive the Updates straight to your inbox, visit CATIE’s free subscription page.

Decisions about particular medical treatments should always be made in consultation with a qualified medical practitioner who is knowledgeable about HIV and hepatitis C-related illnesses and the treatments in question. More…

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Read what a Medical Health Officer with VCH has to say about it.

Just a reminder that once you receive the package, if you are unable to attend the AGM, all voting ballots must be received by January 19th.

We look forward to seeing you all in January!

Healthy Pathways Forward Progress Report

BC provides an opportunity for patients, caregivers AND patient groups to give input into the Drug Review process. This BC Pharmacare website provides a description of how to provide input through “YOUR VOICE”.  http://www.health.gov.bc.ca/pharmacare/yourvoice/

From this website, you can fill in your e-mail to get automatically notified whenever a new drug has been listed for feedback under “YOUR VOICE”. For this option click on “subscription service”. Right now, Boceprevir (VICTRELIS) is listed on the web page and it indicates that “DATES ARE AVAILABLE SOON” for patients/caregivers and advocacy groups to input.

Go to the left hand side of the page and make your selection (i.e. “PATIENTS” OR “CAREGIVERS” OR “ADVOCACY GROUPS”). Note:  “CAREGIVERS” does not include individuals that care for a group of people with a certain disease/condition, it only includes people who look after individual patients with the disease/condition, for instance family members or friends.

Once you choose one of the categories, (i.e. “PATIENTS”, another drop down menu appears entitled “DRUG REVIEW LIST”. Clicking on that takes you to the current product/s open for providing input. The questions that will be asked are specific to the product being reviewed.  Boceprevir (VICTRELIS) will be listed for input soon.

Given that Boceprevir (VICTRELIS) was granted a PRIORITY REVIEW by BC Pharmacare, “YOUR VOICE” for this new drug will be open around November 7 for about a 3 weeks – this is the only chance to give any input about the need for this drug to be listed.

VICTRELIS Fact Sheet PDF

Each year, the World Hepatitis Alliance (WHA) and the World Health Organization (WHO) coordinate World Hepatitis Day globally.  The Canadian Society for International Health (CSIH) coordinates World Hepatitis Day in Canada (websites are listed below).

The World Hepatitis Day campaign theme this year is “This is hepatitis…” with the slogan of “Know it.  Confront it. Hepatitis affects everyone, everywhere.”

World Hepatitis Day 2011 takes place July 28^th.   This year, the Pacific Hepatitis C Network, AIDS Network Kootenay Outreach and Support Society (ANKORS), the BC Centre for Disease Control (BCCDC) and the Provincial Health Services Authority’s HIV Program partnered with film industry professionals, many of whom volunteered all or most of their time and expertise, to create the short, BC-produced, globally released video, ‘Living with Hepatitis’, about the reality of living with hepatitis C.

Thirteen courageous and amazing British Columbians stepped forward to tell their stories to the world.  They did so to help raise awareness and increase understanding about this virus, and its effects and what needs to be done to address those effects.

For more information about the project please be in touch with Deb Schmitz at the Pacific Hepatitis C Network at deb@pacifichepc.org or 604 886 9539.

To learn more about World Hepatitis Day go to these websites:

http://www.worldhepatitisalliance.org/WorldHepatitisDay.aspx

http://www.whdcanada.ca

Posted: June 23, 2011

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, June 22 (HealthDay News) — The recently approved drug Incivek, combined with two standard drugs, is highly effective at treating hepatitis C, a notoriously difficult-to-manage liver disease, two new studies show.

The drug works not only in patients just starting treatment, but in those who failed earlier treatment, the research found.

The hepatitis C virus can lurk in the body for years, causing liver damage, cirrhosis and even liver failure.

“This is a significant advance in the treatment of hepatitis C,” said Dr. David Bernstein, chief of the division of gastroenterology, hepatology and nutrition at North Shore University Hospital in Manhasset, N.Y., who was not involved in either study.

“We know that if we can get rid of the hepatitis C, we can prevent the progression of [liver] disease,” he said. “This means we can prevent the progression of cirrhosis, we can prevent the development of cancer and also prevent the need for liver transplantation in a large number of people.”

Incivek (telaprevir) was approved by the U.S. Food and Drug Administration in May and is the second drug in a class of drugs called protease inhibitors to be approved to fight hepatitis C. The other drug, called Victrelis (boceprevir), was also approved in May.

The standard treatment for hepatitis C has been a combination of two drugs, pegylated-interferon and ribavirin, which are given for a year. If protease inhibitors such as Incivek are added to the mix, the “viral cure” rate improves and the treatment time is reduced to six months, researchers found.

Both reports were published in the June 23 online edition of the New England Journal of Medicine.

In one study, a Phase 3 trial known as ADVANCE, patients were randomly assigned to either a placebo or the treatment in a double-blind study, which means that neither the patients nor the researchers know who’s getting the drug and who’s getting a sham treatment. This type of study is considered the gold standard for clinical research.

In the ADVANCE trial, 1,088 patients with hepatitis C who had never been treated for the condition were randomly assigned to standard therapy for 48 weeks, or telaprevir combined with standard therapy for eight or for 12 weeks, followed by standard therapy alone for a total treatment time of either 24 or 48 weeks.

The researchers found that 79 percent of those receiving Incivek for the longest period (24 weeks) had a “sustained response,” which basically means their hepatitis C was contained. Among those receiving standard care, 44 percent had a sustained response, the researchers noted.

“We have entered a new era of therapy for hepatitis C, which enables us to cure many more patients than we could before,” said lead researcher Dr. Ira M. Jacobson, from Weill Cornell Medical College in New York City.

Incivek needs to be given along with pegylated-interferon and ribavirin, Jacobson said. The researchers learned early on that Incivek alone reduces the level of the virus, but later the virus can become resistant to the drug, he said.

For the second study, called the REALIZE trial, 663 patients with hepatitis C who had failed standard therapy were divided into three groups. One group received Incivek plus standard therapy, another group was started on pegylated-interferon and ribavirin and then had Incivek added. The third group received standard therapy alone.

Here, the researchers found up to an 88 percent sustained response in patients receiving Incivek, compared with a 24 percent sustained response in the standard treatment group.

“These drugs represent a real milestone in the treatment of this disease,” said lead researcher Dr. Stefan Zeuzem, a professor of medicine at J.W. Goethe University Hospital in Frankfurt, Germany.

“There were very limited treatment options in the past, but now many patients have excellent chances to be cured, even if they already have advanced disease,” he said.

Bernstein noted that in the past, these patients could only be treated with more of the standard therapy for a longer period and the “cure” rate was only 10 percent. “Now you can treat these patients for six months with cure rates approaching 90 percent,” he said. “You are really offering hope to a large number of patients.”

side effects were serious enough to cause a few participants to drop out, according to the study.

Incivek, made by Vertex Pharmaceuticals Inc., is sold to wholesalers for $49,200 for a four-week course of treatment, said Vertex spokeswomen Nikki Levy.

While both Incivek and Victrelis are important breakthroughs in the treatment of hepatitis C, new drugs with even fewer side effects and perhaps shorter treatment times are in clinical trials, Bernstein said.

Hepatitis C affects almost 4 million Americans, most of whom don’t know they’re infected. Often there are no symptoms, but it is the leading cause of liver transplantation in the United States and is linked to as many as 12,000 deaths a year, the researchers say.

More information

For more on hepatitis C, visit the U.S. National Institutes of Health.

Copyright © 2011 HealthDay. All rights reserved.

Sign to support evidence-based drug policy

The federal government of Canada is currently considering Bill S-10, which proposes legislative amendments that, among other things, would introduce mandatory minimum prison sentences for certain drug-related offenses. Research clearly demonstrates that mandatory minimum sentences are extremely expensive to the taxpayer and do not meaningfully improve public health and safety nor reduce drug use or crime in our communities.

We invite other concerned health practitioners, scientists, researchers and academics in Canada to join us in supporting evidence-based drug prevention and treatment initiatives and opposing the introduction of costly and ineffective mandatory minimum sentencing legislation, by signing the letter below.

Thank you!

Please scroll down to read the letter

To sign the letter, click here

Right Hon. Stephen Harper, Prime Minister, Leader of the Conservative Party of Canada
Hon. Michael Ignatieff, Leader of the Liberal Party of Canada
Hon. Jack Layton, Leader of the New Democratic Party of Canada
Mr. Gilles Duceppe, Leader of the Bloc Québécois
House of Commons
Parliament Buildings
Ottawa, Ontario  K1A 0A6

Dear Sirs:

Re: Opposition to Bill S-10, the Penalties for Organized Crime Act

We, the undersigned, are concerned that the federal government is pursuing significant amendments to federal drug legislation, through Bill S-10, which are not scientifically grounded and which research demonstrates may actually contribute to health and social harms in our communities. We join with other individuals and community groups that have previously expressed concerns in their testimony to various Committees and in open letters, and we outline our key concerns, in brief, below.

We oppose Bill S-10

We are extremely concerned that Bill S-10 will exacerbate drug use challenges and related health and social harms in Canadian communities. Specifically, we are concerned that:

1. There is no evidence that mandatory minimum sentences will reduce drug use or deter crime. Research from the United States demonstrates that mandatory minimum penalties are a considerable burden on the taxpayer and are not effective in reducing drug use or drug-related crime. It is especially concerning that while several states in the US, such as New York, Washington, Texas, Connecticut and Maine, are now repealing and moving away from costly and ineffective mandatory minimum sentencing legislation, Canada is moving towards this failed and expensive policy approach.
2. Mandatory minimum sentences have a disproportionately negative impact on youth and Aboriginal persons. In Canada, mandatory minimum sentences will most negatively affect Aboriginal people, and particularly youth, who already face elevated risks related to and harms associated with substance abuse, are at increased risk of HIV infection and are disproportionately incarcerated. Over the last three decades, the proportion of Aboriginal persons admitted into correctional institutions in Canada has doubled from 9% to 18%, despite only representing 3% of the total population of Canada. Bill S-10’s emphasis on mandatory minimum sentences will likely lead to worsening drug-related harms experienced by Aboriginal persons, and does nothing to address the underlying causes contributing to these unacceptable disparities.
3. Policies that over-emphasize drug law enforcement have a negative impact on public health and rates of HIV. According to the Correctional Service of Canada, approximately one in twenty inmates is already HIV-positive and one in three has hepatitis C (HCV). Rates of infectious diseases continue to climb among this population. The House of Commons Standing Committee on Public Safety and National Security recently raised concerns regarding the inadequate level of care and supports for inmates who suffer from mental health and addictions challenges, and stressed that community resources should be augmented to avoid incarcerating this population in the first place. The pending legislation, if implemented, will result in additional prison overcrowding and can be expected to contribute to further increased HIV and HCV risk behaviour in prison. This has serious implications for public health, given that most inmates will be released and reintegrated into the community. It also has implications for healthcare budgets, as the average health costs of each case of HIV infection are estimated to be $250,000.
4. Mandatory minimum sentences are expensive and ineffective. Although the government has not produced detailed budget estimates regarding the potential cost of implementing mandatory minimum sentences, similar sentencing regimes introduced in the United States have cost taxpayers billions of dollars. During these difficult economic times, this raises the question of why the federal government proposes to spend scarce financial resources on policies that have been shown to be expensive, ineffective and harmful. The reasons given by US jurisdictions for moving away from mandatory minimum sentencing legislation are the extreme costs to taxpayers, the ineffectiveness of this approach, and the resulting disproportionate harms to ethnic minority communities.

We support evidence-based drug policies

The Legislative Summary for Bill S-10 outlines no evidence supporting mandatory minimum sentences as an effective means of improving public health and community safety, or deterring crime. We support the goal of improving community health and safety through evidence-based drug policies, which includes expanding drug prevention and treatment initiatives. We encourage you to use the recommendations of the World Health Organization and the Vienna Declaration, a scientific statement endorsed by leading scientists, researchers and health professionals around the world, to guide Canada’s drug policy.

We share the government’s commitment to addressing the challenges of substance abuse but do not support the implementation of non-evidence-based policies, such as Bill S-10, which place an enormous burden on taxpayers and will cause considerable health-related harms, while failing to improve community health and safety.

We are calling on the federal government to demonstrate leadership in addressing these challenging issues by abandoning Bill S-10 and pursuing an evidence-based policy approach that moves away from ineffective and costly incarceration schemes for non-violent drug offenders and towards evidence-based modalities. We invite you to work together with the public health community to develop scientifically grounded policies that meaningfully address drug-related health and social harms, are fiscally responsible, and are “smart on crime.”

We look forward to your response.

Signed,

[list of signatories]

Cc: Members of Parliament of Canada

To sign the letter, click here

Study participants (women over 19 who have received a Hepatitis C diagnosis) wanted for a thesis titled: “Lived Experiences of Women Receiving a Hepatitis C Diagnosis”.

Tell me about your health experience and living with Hepatitis C.

All information shared is confidential.

Participants must be within a 2-hour drive of Kelowna, and the researcher (Donna) will travel to your town/city to talk with you. The ethics are approved through the University of Victoria.

Contact Donna RN BScN (Master of Nursing student) for more information at

donnazuk@uvic.ca or 250-870-1902