scholarly journals CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian Guidelines for Management and Treatment of HIV/Hepatitis C Coinfection in Adults

2013 ◽  
Vol 24 (4) ◽  
pp. 217-238 ◽  
Author(s):  
Mark Hull ◽  
Marina Klein ◽  
Stephen Shafran ◽  
Alice Tseng ◽  
Pierre Giguère ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Standard Of Care ◽  
Dual Therapy ◽  
Pegylated Interferon ◽  
National Standards ◽  
Clinical Expertise ◽  
Direct Acting Antiviral ◽  
Hcv Therapy ◽  
Genotype 2

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV-HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens.OBJECTIVE: To develop national standards for the management of HCV-HIV coinfected adults in the Canadian context.METHODS: A panel with specific clinical expertise in HIV-HCV co-infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality-of-evidence scale.RESULTS: All HIV-HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight-based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2–6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients.DISCUSSION: Recommendations may not supersede individual clinical judgement.

scholarly journals A hepatitis C-vírus-fertőzés szűrése, diagnosztikája, antivirális terápiája, kezelés utáni gondozása. Magyar konszenzusajánlás. Érvényes: 2016. október 15-től

2017 ◽  
Vol 158 (Supplement 1) ◽  
pp. 3-22 ◽  
Author(s):  
Béla Hunyady ◽  
Zsuzsanna Gerlei ◽  
Judit Gervain ◽  
Gábor Horváth ◽  
Gabriella Lengyel ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Disease Risk ◽  
Dual Therapy ◽  
Pegylated Interferon ◽  
Insurance Fund ◽  
Hepatic Decompensation ◽  
Direct Acting Antiviral ◽  
Pegylated Interferon Plus Ribavirin ◽  
Direct Acting

Treatment of hepatitis C is based on a national consensus guideline updated six-monthly according to local availability and affordability of approved therapies through a transparent allocation system in Hungary. This updated guideline incorporates some special new aspects, including recommendations for screening, diagnostics, use and allocation of novel direct acting antiviral agents. Indication of therapy in patients with no contraindication is based on demonstration of viral replication with consequent inflammation and/or fibrosis in the liver. Non-invasive methods (elastographies and biochemical methods) are preferred for liver fibrosis staging. The budget allocated for these patients is limited. Therefore, expensive novel direct acting antiviral combinations as first line treatment are reimbursed only, if the freely available, but less effective and more toxic pegylated interferon plus ribavirin dual therapy deemed to prone high chance of adverse events and/or low chance of cure. Priority is given to those with urgent need based on a pre-defined scoring system reflecting mainly the stage of the liver disease, but considering also additional factors, i.e., hepatic decompensation, other complications, activity and progression of liver disease, risk of transmission and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained virological response value in different patient categories with consensus amongst treating physicians, the National Health Insurance Fund and patient’s organizations. Interferon-free treatments and shorter therapy durations are preferred. Orv. Hetil., 2017, 158(Suppl. 1), 3–22.

scholarly journals CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 Updated Canadian HIV/Hepatitis C Adult Guidelines for Management and Treatment

2016 ◽  
Vol 2016 ◽  
pp. 1-34 ◽  
Author(s):  
Mark Hull ◽  
Stephen Shafran ◽  
Alex Wong ◽  
Alice Tseng ◽  
Pierre Giguère ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Pegylated Interferon ◽  
Virologic Response ◽  
National Standards ◽  
Direct Acting Antiviral ◽  
Canadian Context ◽  
Heavy Burden ◽  
Hcv Coinfection ◽  
Direct Acting ◽  
Living With Hiv

Background. Hepatitis C virus (HCV) coinfection occurs in 20–30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality.Purpose. To update national standards for management of HCV-HIV coinfected adults in the Canadian context with evolving evidence for and accessibility of effective and tolerable DAA therapies. The document addresses patient workup and treatment preparation, antiviral recommendations overall and in specific populations, and drug-drug interactions.Methods. A standing working group with HIV-HCV expertise was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published HCV antiviral data and update Canadian HIV-HCV Coinfection Guidelines.Results. The gap in sustained virologic response between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All coinfected individuals should be assessed for interferon-free, Direct Acting Antiviral HCV therapy. Regimens vary in content, duration, and success based largely on genotype. Reimbursement restrictions forcing the use of pegylated interferon is not acceptable if optimal patient care is to be provided.Discussion. Recommendations may not supersede individual clinical judgement. Treatment advances published since December 2015 are not considered in this document.

scholarly journals THE ECONOMIC IMPACT OF TREATING CHRONIC HEPATITIS C

2019 ◽  
Vol 34 (4) ◽  
pp. 1153-1157
Author(s):  
Evgenija Nikolovska ◽  
Velo Markovski
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Dual Therapy ◽  
Pegylated Interferon ◽  
Economic Problem ◽  
Decompensated Cirrhosis ◽  
Healthy Population ◽  
Genotype 2 ◽  
Direct Acting

Hepatitis C is a viral infection of the liver. This infection is a global problem because over 180 million people worldwide have chronic hepatitis type C (about 3% of the world's population). The highest prevalence occurs among intravenous drug addicts (about 52%), the virus can be transmitted from mother to child during childbirth (4-8%), and further the virus is transmitted through medical interventions, piercing, tattooing. In the Republic of Macedonia in the period from 2011 to 2017, 511 newly infected with Hepatitis C from a total of 31 municipalities were registered. Among the healthy population in Macedonia, 0.4% were positive for HCV, while among the risk groups, 23% -52% were positive for HCV. In Macedonia, the groups at highest risk of HCV are: people who inject drugs (with a prevalence of 51.53%), people who are being treated with hemodialysis (with a prevalence of 37.91%), people who have become infected with HCV by transfusion (with a prevalence of 1,48%), people who have become HCV infected in other risky ways (with a prevalence of 9,08%). Hepatitis C virus is a serious health, but also an economic problem. Treatment of hepatitis C is expensive and therefore hardly accessible to people motivated to heal from hepatitis C. Тhe treatment of patients with chronic hepatitis C was performed with a combination of pegylated interferon alfa and ribavirin (dual therapy) for 24 or 48 weeks. Early detection of HCV infection is very important, because chronic hepatitis C is already a treatable disease, until the stage of decompensated cirrhosis and / or HCC. Disease control is successfully achieved by 30-60% with standard interferon, 40-70% depending on the genotype with pegylated interferon (in combination with ribavirin), and 40-90% with new direct-acting antivirals (DAAs). In addition, the benefit of treatment is that it reduces the risk of further spread of the virus. Treatment with the most recent direct-acting drugs (DAAs) started in 2011, lasts much shorter, 12 to 24 weeks, has the least risky effects and the highest percentage of negativity (up to 90%) but is not yet widely used (expensive in many countries not yet registered ). For example, sophosuvir is only regressed in some richer countries, and treatment with it costs about $ 84,000 ($ 1,000 per pill). In 2011, treatment with Copegus and Pegasus for 48 weeks of treatment, for patients under 75 kg, required a total of 1,215,974 MKD (44,831 MKD cost per one Copegus package and 15,993 MKD for a Pegasus injection). For patients over 75 kg the total cost is 1,305,636 MKD. For genotype 2 and 3 the total costs for all patients regardless of body weight were 563,156 MKD. Total costs in 2017 for Copegus and Pegasus for 48 weeks of treatment for patients with Hepatitis C genotype 1 and 4 in Macedonia cost 655,964 MKD, which means a 46% decrease compared to 2011.

Viral Hepatitis C: Treatment

2018 ◽  
Author(s):  
Jay Luther ◽  
Raymond T. Chung ◽  
Anna Lidofsky ◽  
Jacinta A Holmes ◽  
Stephanie M Rutledge
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Agents ◽  
Pegylated Interferon ◽  
Direct Acting Antiviral ◽  
Hcv Therapy ◽  
Viral Hepatitis C ◽  
Pegylated Interferon Plus Ribavirin ◽  
Direct Acting ◽  
Direct Acting Antiviral Agents

Infection with the hepatitis C virus (HCV) leads to chronic infection in the majority, and is associated with the development of complications including cirrhosis, end-stage liver failure, hepatocellular carcinoma and death. HCV is curable, and successful viral eradication is associated with a reduction in cirrhosis and liver-related mortality. However, previous HCV therapy, consisting of pegylated interferon plus ribavirin, was associated with poor cure rates and significant adverse events. The development of direct-acting antiviral agents (DAAs) that specifically target HCV replication has revolutionized the treatment of HCV. Current regimens are now highly potent, all-oral, interferon-free combinations of these DAAs. The Food and Drug Administration has now approved many of these regimens. The changing management of HCV infection, including recent advances in HCV therapy, are discussed. This review contains 1 figure, 5 tables and 59 references Key words: direct-acting antiviral agents, hepatitis C virus, interferon-free therapy, management, treatment

New direct-acting antiviral agents for the treatment of hepatitis C virus infection and perspectives

Gut ◽  
2012 ◽  
Vol 61 (Suppl 1) ◽  
pp. i36-i46 ◽  
Author(s):  
Christoph Welsch ◽  
Arun Jesudian ◽  
Stefan Zeuzem ◽  
Ira Jacobson
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Agents ◽  
Pegylated Interferon ◽  
The Novel ◽  
Genotype 1 ◽  
Direct Acting Antiviral ◽  
Hcv Therapy ◽  
Direct Acting ◽  
Direct Acting Antiviral Agents

Until recently, the standard of care (SOC) for patients with chronic hepatitis C virus (HCV) infection has consisted of a combination of pegylated interferon-N1 plus ribavirin, administered for 24- to 48-weeks depending on the HCV genotype. The sustained virologic response rate for this SOC has been only about 50% in patients infected with genotype 1 HCV, the most prevalent genotype in Europe and North America. HCV therapy has been revolutionised recently by the approval of two direct-acting antiviral agents (DAA) against the NS3/4A serine protease for use in genotype 1 HCV, the ketoamide inhibitors boceprevir and telaprevir. The novel SOC marks the beginning of an extraordinary new era in HCV therapy. We review this new SOC with an emphasis on practical issues related to protease inhibitors, e.g. prescribing guidelines, futility rules and management of adverse events. We also give a perspective on what to expect in the coming years. Newer DAA with simplified dosing regimens and/or minimal toxicity which, when used in combination, will lead to viral eradication in most if not all CHC patients who undergo treatment. The novel agents in clinical development are paving the way for future interferon-sparing regimens.

scholarly journals CIHR Canadian HIV Trials Network Co-Infection and Concurrent Diseases Core: Updated Canadian Guidelines for the Treatment of Hepatitis C Infection in HIV-hepatitis C Coinfected Adults

2014 ◽  
Vol 25 (6) ◽  
pp. 311-320 ◽  
Author(s):  
Mark Hull ◽  
Stephen Shafran ◽  
Alice Tseng ◽  
Pierre Giguère ◽  
Marina B Klein ◽  
...  
Keyword(s):  
Hepatitis C ◽  
National Standards ◽  
Published Data ◽  
Line Treatment ◽  
Hepatitis C Infection ◽  
First Line ◽  
Hcv Therapy ◽  
Genotype 2 ◽  
Hcv Coinfection ◽  
First Line Treatment

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Management of HIV-HCV coinfection is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens.OBJECTIVE: To update national standards for the management of HCV-HIV coinfected adults in the Canadian context.METHODS: A standing working group with specific clinical expertise in HIV-HCV coinfection was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published data regarding HCV antiviral treatments and to update the Canadian HIV-HCV coinfection guidelines.RESULTS: Recent data suggest that the gap in sustained virological response rates between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All HIV-HCV coinfected individuals should be assessed for HCV therapy. First-line treatment for genotypes 1 through 6 includes pegylated interferon and weight-based ribavirin dosing plus the nucleotide sofosbuvir for 12 weeks. Sofosbuvir in combination with the protease inhibitor simeprevir is another first-line consideration for genotype 1 infection. Sofosbuvir with ribavirin for 12 weeks (genotype 2) and 24 weeks (genotype 3) is also recommended as first-line treatment.DISCUSSION: Recommendations may not supersede individual clinical judgement.

scholarly journals Pegylated interferon-alfa plus ribavirin therapies for chronic hepatitis C

2011 ◽  
Vol 51 (181) ◽  
Author(s):  
T Kanda ◽  
O Yokosuka
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Antiviral Agents ◽  
Standard Of Care ◽  
Pegylated Interferon ◽  
New Drugs ◽  
Direct Acting Antiviral ◽  
New Information ◽  
Direct Acting

Until HCV NS3/4A protease inhibitors become available at the end of 2011, the combination pegylated-interferon (PEG-IFN)-alfa and ribavirin (RBV) will remain the standard treatment for chronic hepatitis C patients. In some hepatitis C virus-infected patients, PEG-IFN plus RBV treatment against HCV should continue to be used because of side effects of new drugs such as anemia. Our Japanese experiences should provide new information for the treatment of chronic hepatitis C.  Keywords: Direct-acting antiviral agents (DAA), HCV, pegylated interferon, ribavirin, standard of care (SOC ).

Viral Hepatitis C: Treatment

2018 ◽  
Author(s):  
Jay Luther ◽  
Raymond T. Chung ◽  
Anna Lidofsky ◽  
Jacinta A Holmes ◽  
Stephanie M Rutledge
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Agents ◽  
Pegylated Interferon ◽  
Direct Acting Antiviral ◽  
Hcv Therapy ◽  
Viral Hepatitis C ◽  
Pegylated Interferon Plus Ribavirin ◽  
Direct Acting ◽  
Direct Acting Antiviral Agents

Infection with the hepatitis C virus (HCV) leads to chronic infection in the majority, and is associated with the development of complications including cirrhosis, end-stage liver failure, hepatocellular carcinoma and death. HCV is curable, and successful viral eradication is associated with a reduction in cirrhosis and liver-related mortality. However, previous HCV therapy, consisting of pegylated interferon plus ribavirin, was associated with poor cure rates and significant adverse events. The development of direct-acting antiviral agents (DAAs) that specifically target HCV replication has revolutionized the treatment of HCV. Current regimens are now highly potent, all-oral, interferon-free combinations of these DAAs. The Food and Drug Administration has now approved many of these regimens. The changing management of HCV infection, including recent advances in HCV therapy, are discussed. This review contains 1 figure, 5 tables and 59 references Key words: direct-acting antiviral agents, hepatitis C virus, interferon-free therapy, management, treatment

Viral Hepatitis C: Treatment

2018 ◽  
Author(s):  
Jay Luther ◽  
Raymond T. Chung ◽  
Anna Lidofsky ◽  
Jacinta A Holmes ◽  
Stephanie M Rutledge
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Agents ◽  
Pegylated Interferon ◽  
Direct Acting Antiviral ◽  
Hcv Therapy ◽  
Viral Hepatitis C ◽  
Pegylated Interferon Plus Ribavirin ◽  
Direct Acting ◽  
Direct Acting Antiviral Agents

Infection with the hepatitis C virus (HCV) leads to chronic infection in the majority, and is associated with the development of complications including cirrhosis, end-stage liver failure, hepatocellular carcinoma and death. HCV is curable, and successful viral eradication is associated with a reduction in cirrhosis and liver-related mortality. However, previous HCV therapy, consisting of pegylated interferon plus ribavirin, was associated with poor cure rates and significant adverse events. The development of direct-acting antiviral agents (DAAs) that specifically target HCV replication has revolutionized the treatment of HCV. Current regimens are now highly potent, all-oral, interferon-free combinations of these DAAs. The Food and Drug Administration has now approved many of these regimens. The changing management of HCV infection, including recent advances in HCV therapy, are discussed. This review contains 1 figure, 5 tables and 59 references Key words: direct-acting antiviral agents, hepatitis C virus, interferon-free therapy, management, treatment

scholarly journals Virological Factors Associated with Failure to the Latest Generation of Direct Acting Agents (DAA) and Re-Treatment Strategy: A Narrative Review

Viruses ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 432
Author(s):  
Lorenzo Onorato ◽  
Mariantonietta Pisaturo ◽  
Mario Starace ◽  
Carmine Minichini ◽  
Alessandra Di Fraia ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Antiviral Agents ◽  
Clinical Problem ◽  
Narrative Review ◽  
Factors Associated ◽  
Direct Acting Antiviral ◽  
Direct Acting ◽  
The Impact ◽  
Direct Acting Antiviral Agents

The availability of all oral direct acting antiviral agents (DAAs) has revolutionized the management of HCV infections in recent years, allowing to achieve a sustained virological response (SVR) in more than 95% of cases, irrespective of hepatitis C Virus (HCV) genotype or staging of liver disease. Although rare, the failure to the latest-generation regimens (grazoprevir/elbasvir, sofosbuvir/velpatasvir, pibrentasvir/glecaprevir) represents a serious clinical problem, since the data available in the literature on the virological characteristics and management of these patients are few. The aim of the present narrative review was to provide an overview of the impact of baseline RASs in patients treated with the latest-generation DAAs and to analyze the efficacy of the available retreatment strategies in those who have failed these regimens.

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