New and Noteworthy
In this issue:
- Harvoni and sofosbuvir added to formularies in Alberta, Nova Scotia and Saskatchewan
- Sexual transmission of Hep C linked to anal sex, drug use and lower CD4 count
- Re-infection is likely the cause of Hep C recurrence after being cured from treatment
Harvoni and sofosbuvir added to formularies in Alberta, Nova Scotia and Saskatchewan
Alberta, Nova Scotia and Saskatchewan have added Harvoni and sofosbuvir (Sovaldi) to their provincial formularies. When a medication is added to a provincial or territorial formulary it means that people without private health insurance can apply to have these medications covered by the formulary. However, there may be some eligibility requirements to access the medications.
Harvoni is a combination of two medications, ledipasvir and sofosbuvir. They are combined into one pill that is taken once per day. Harvoni is on the formulary for people with genotype 1 virus.
Sofosbuvir is taken with peg-interferon and/or ribavirin depending on what genotype a person has. Sofosbuvir is on the formulary for people with genotypes 1, 2 or 3 virus.
In March 2015, British Columbia, Ontario, New Brunswick and Yukon also added Harvoni and sofosbuvir to their formularies. (ctv.ca, March 2015, in English)
Sexual transmission of Hep C linked to anal sex, drug use and lower CD4 count
In addition to the usual risk factors for Hep C sexual transmission seen in previous studies, such as condomless anal sex, group sex and having STIs, a new study has found an association between snorting drugs, injection drug use and lower CD4 count and Hep C sexual transmission, reported researchers at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI).
All of the 213 participants in the study were HIV-positive men who have sex with men. 82 participants had acute Hep C and 131 participants did not have Hep C. The men without Hep C served as a comparison group for the men with Hep C. All participants filled out questionnaires about risk factors six months prior to entry in the study.
The risk factors that were found to be associated with an increased likelihood of having acute Hep C included:
- Injection drug use
- Having an STI that causes ulcers (syphilis, genital herpes, lymphogranuloma venereum)
- Condomless receptive anal sex
- Sharing sex toys
- Sharing straws for snorting drugs
- Fisting without a glove
- Low CD4 count
The number of casual sex partners, anal rinsing or douching, rectal bleeding and meeting partners at sex parties were not linked to sexual transmission of Hep C.
According to the researchers, “Our study confirms sexual transmission and a role of non-injecting drug use as a risk factor for HCV transmission. Further studies are needed on the role of CD4 cell count, as it is still unclear whether a lower CD4 cell count facilitates HCV infection or is a result of acute HCV infection itself (or both).” (HIVandhepatitis.com, March 2015, in English)
Re-infection is likely the cause of Hep C recurrence after being cured from treatment
Hep C recurrence is probably caused by re-infection after people are cured from Hep C treatment, reported researchers at CROI, after comparing rates of hepatitis C recurrence in groups of people with different levels of risk of being re-infected with Hep C.
A minority of people with Hep C who are cured from treatment have Hep C recur. However, many of these people are still at risk for Hep C infection, so it is possible that the recurrence is caused by re-infection rather than a return of the previous infection, also known as relapse.
The researchers did a meta-analysis of 49 studies with a total of over 8000 participants, looking at Hep C recurrence among people who had previously taken Hep C treatment and were cured. They divided the studies into three groups:
- Low risk (people with no risk factors for re-infection)
- High risk (prisoners and people who use injection drugs)
- People co-infected with Hep C and HIV, who were cured of Hep C
People categorized as low risk for re-infection had a 5-year recurrence rate of just over 1%, meaning that over a five year period an estimated 1% of people in this group would become re-infected with Hep C.
People categorized as high risk for re-infection had a 13% 5-year recurrence rate, and people co-infected with Hep C and HIV had a 22% 5-year recurrence rate.
Because of the large differences in outcomes between risk groups, the researchers concluded that most Hep C recurrences are due to re-infection rather than relapse. (March 2015, in English)