Hep C World News - Week of March 30, 2025

Statin use linked with reduced risks in chronic liver disease

Boston, MA - Statin use in patients with chronic liver disease was associated with a reduced risk of hepatocellular carcinoma (HCC) and hepatic decompensation, researchers found. In a cohort of 16,501 individuals with chronic liver disease, statin users exhibited a significantly lower 10-year cumulative incidence of HCC compared with nonusers (3.8% vs 8%; adjusted subhazard ratio [aSHR] 0.67, 95% CI 0.59-0.76), as well as a lower incidence of hepatic decompensation (10.6% vs 19.5%; aSHR 0.78, 95% CI 0.67-0.91), reported Raymond Chung, MD, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues. The study in JAMA Internal Medicine also found that exposure to lipophilic statins and longer duration of statin use were associated with further reductions in HCC and hepatic decompensation risks, while statin use also reduced liver fibrosis progression as indicated by Fibrosis-4 (FIB-4) transitions over time. "These findings underscore the potential of statins as chemo preventive agents against HCC through their role in mitigating fibrosis progression," wrote Chung and colleagues. The authors used 2000-2023 data from the Research Patient Data Registry -- which pulls records from hospitals within Mass General Brigham -- on patients 40 years or older with chronic liver disease and baseline FIB-4 scores. These patients had a mean age of 60 years, 41% were women, and 79% were white. Among them, 3,160 reported statin use and 12,891 were nonusers. Seven statins were evaluated, including five lipophilic statins (atorvastatin, fluvastatin, lovastatin, pitavastatin, and simvastatin) and two hydrophilic statins (rosuvastatin and pravastatin). Use was defined by cumulative defined daily dose (cDDD), with exposure levels categorized as less than 30, 30-599, and 600 cDDD or higher. Median follow-up was 2.8 years for nonusers and 4.6 years for statin users, during which 755 incident cases of HCC and 2,011 cases of hepatic decompensation occurred. When stratified by statin use duration, patients with a cDDD of 600 or more had the lowest 10-year cumulative incidence of HCC (3.5% vs 8% among nonusers; aSHR 0.60, 95% CI 0.52-0.70), while those in the 30-599 cDDD group had a cumulative incidence of 3.8% (aSHR 0.79, 95% CI 0.67-0.93).For hepatic decompensation, patients with 600 or higher cDDD also exhibited the greatest reduction, with a 10-year cumulative incidence of 9.1% compared with 19.5% in nonusers (aSHR 0.64, 95% CI 0.51-0.80). Those with 30-599 cDDD had a cumulative incidence of 12.3% (aSHR 0.87, 95% CI 0.75-1.01). Among 7,038 patients with serial FIB-4 data, 14.7% of those who had intermediate baseline FIB-4 scores transitioned to the high group compared with 20% of nonusers. For patients with high baseline FIB-4 scores, 31.8% of statin users transitioned to the intermediate group and 7% transitioned to the low-risk group, compared with 18.8% and 4.3% of nonusers, respectively. Chung and colleagues also found differences in HCC risk among statin types. While both lipophilic and hydrophilic statins were significantly associated with a reduced HCC risk, the association was stronger with lipophilic statins. Hydrophilic statin users had a 10-year cumulative HCC incidence of 4.1% compared with 8% among nonusers (aSHR 0.79, 95% CI 0.63-0.99), while lipophilic statin users demonstrated an even lower, 3.7% 10-year cumulative incidence of HCC (aSHR 0.64, 95% 0.55-0.73). The authors acknowledged several limitations to the study, including its nonrandomized design and the range of confounders that could have affected the observed associations. "Although randomized clinical trials to evaluate statins in HCC prevention are ideal, they would require large-scale enrollment and long-term follow-up, making them difficult to conduct," they wrote. "Well-designed historical cohort studies such as ours provide valuable insights into the intermediate pathways through which statins reduce HCC risk and fibrosis progression."

For more information: https://tinyurl.com/mtpkpev9

Hep C World News - Week of March 23, 2025

Study finds high rates of depression and anxiety in people with chronic pain

Baltimore, Maryland - A novel analysis of more than 375 published studies concluded that the association between chronic pain and rates of depression and anxiety is staggering. The study, led by investigators at Johns Hopkins Medicine found that 40% of adults with chronic pain experienced "clinically significant depression and anxiety." Among those most at risk, the analysis showed, were women, younger adults and people with fibromyalgia. For decades, research has provided evidence of clear links between pain and mood, but the new study's leaders say the co-occurrence levels they identified pose a significant public health concern that should require routine screening in clinical settings, better access to specialty care and development of innovative therapies. Historically, studies show that people with chronic pain and both depression and anxiety lack consistent access to specialized pain clinics focused on acute pain, and are routinely excluded from clinical trials for pain management. Chronic pain, described as pain that persists for greater than three months, can be a debilitating condition. According to the Centers for Disease Control and Prevention, an estimated 20.9% of U.S. adults (51.6 million people) experienced chronic pain in 2021. Patients who have chronic pain exhibit symptoms of depression and anxiety. In fact, studies show that 20-40% of adults with chronic pain have co-occurring depression and anxiety. "Right now, we have effective psychological treatments for depression and anxiety, and effective psychological treatments for chronic pain, but these treatments are often siloed. In fact, many studies exclude people who with chronic pain who have depression or anxiety from clinical trials. We need integrated treatments that address chronic pain and mental health together," says Rachel Aaron, Ph.D., first author of the study and assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. For the new study, researchers analyzed data published in 376 studies with a focus on estimating the prevalence of depression and anxiety in people with chronic pain around the world. Their findings, which compared rates of depression and anxiety in people with and without chronic pain, were based on clinical symptoms in medical records; criteria for anxiety and depression found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5); and consideration and adjustment of factors such as geographic location, clinical versus community settings for data gathering, age, gender and pain duration. The findings, published Mar. 7 in JAMA Network Open, indicate that adult patients with chronic pain were more likely to have clinical symptoms of depression and anxiety and that elevated depression and anxiety may be unique to chronic pain, rather than being attributed solely to having a medical condition. 

For more information: https://tinyurl.com/4966hs4r

Hep C World News - Week of March 16, 2025

HCV testing guidelines tied to increased screening for pregnant women

Boston, MA - Despite decreased population-level hepatitis C virus screening in 2020, guidance to test all adults and during every pregnancy was associated with increased HCV screening for pregnant women, according to a research letter published in JAMA. In 2020, the CDC updated HCV guidelines to screen all adults at least once and to screen women during every pregnancy. “Screening for HCV increased after the 2020 guidelines to universally screen all adults and pregnant people during each pregnancy. We compared screening rates for women who were pregnant vs. those who were not pregnant, and the increase was more significant for those who were pregnant,” Rachel L. Epstein, MD, MScE, infectious disease clinician-scientist at Boston Medical Center and associate professor of medicine at the Chobanian & Avedisian School of Medicine at Boston University, told Healio. “This implies that prenatal care could be a critical venue to help HCV elimination efforts.” Epstein and colleagues analyzed electronic health records data from 759,591 pregnant and 24,066,400 nonpregnant women across 68 U.S. health care organizations from 2014 to 2022. Researchers compared HCV screening rates for pregnant and nonpregnant women for each 6-month period before and after the 2020 guidelines were released. Overall, there were 79,231 incident HCV tests for pregnant women and 678,951 tests for nonpregnant women. Before the CDC guidance updates, HCV screening increased from 52 to 117 tests per 1,000 person-years for pregnant women and from 16 to 24 tests per 1,000 person-years for nonpregnant women. After the guidance updates, HCV screening increased from 141 to 253 tests per 1,000 person-years for pregnant women and from 29 to 37 per 1,000 person-years for nonpregnant women. By December 2022, 38.73% of pregnant women and 8.67% of nonpregnant women received an HCV test, which is still well below guideline recommendations compared with about 90% of pregnant women tested for HIV by the end of the study. “Prenatal care is an opportune time to apply HCV screening guidelines; test people while they are already having prenatal lab work done and follow up to link them to care to treat and cure their HCV,” Epstein told Healio. “Many young, relatively healthy people don’t see their primary care doctors often. Prenatal care is a great time to reach people and get them diagnosed and treated for their own health and to reduce transmission to future children, as well as to other people.” Data show many people in the U.S. have HCV but are unaware of the diagnosis, Epstein said. With universal screening, everyone can be screened and treated if HCV is identified, she said.  “Education about the guidelines is key. They were published during the first COVID-19 peak in 2020 when outpatient clinics were closed for all but urgent visits generally, and people had many other worries. This likely slowed the uptake,” Epstein told Healio. “Secondly, how are we getting people tested? There has been a recent push for point-of-care testing, in general, which was recently approved in the U.S., but there are still many logistics to be figured out. Finding people where they are is also key — increasing screening in venues such as harm reduction sites and mobile health settings.”

For more information: https://tinyurl.com/2w9kpt9w

Hep C World News - Week of March 9, 2025

New threat to Global Public Health & Viral Hepatitis Elimination

London, UK - The sudden freezing of USAID funds is jeopardising the goal of eliminating viral hepatitis by 2030. In an editorial published 14 February, the Lancet Gastroenterology & Hepatology said efforts to scale up testing for hepatitis B and hepatitis C are at most immediate risk. The editorial pointed out that USAID distributes half of US foreign aid, and its shuttering has had abrupt effects around the globe. Communities are still coming to grips with the repercussions of actions that include withdrawing from WHO, instructing agencies to pause external communications and collaborations, freezes to foreign aid, cuts to funding from the National Institutes of Health (NIH), and a backslide on efforts to improve inclusivity, the editorial said, posing the question: “What are their implications for viral hepatitis elimination, for which progress has already stalled?” Funding for viral hepatitis is already scarce. Rollback of international support might see governments pivot limited resources to focus on diseases that are deemed a higher priority. It said although The Global Fund has recently broadened support for viral hepatitis, reductions to its funding may see it “revert to solely focusing on closing gaps in treatment and prevention for its core diseases.” It noted that USAID was a major donor to the Vaccine Alliance, Gavi, which only launched its hepatitis B birth-dose vaccination program in June 2024, and adding that speculation that the UK may also be planning to cut support to Gavi was deeply alarming. “Funding for viral hepatitis is already scarce. Rollback of international support might see governments pivot limited resources to focus on diseases that are deemed a higher priority.”

For more information: https://tinyurl.com/2yxubpmx

Hep C World News - Week of March 2, 2025

Vertex’s non-opioid pain drug gets FDA approval in milestone for company and research 

Silver Spring, Maryland - Despite high demand for an option like Journavx, doctors fear the drug’s price could be a hangup for insurers, potentially limiting patients’ ability to access it. The movement to steer pain treatment away from opioids notched a major victory Thursday, as the Food and Drug Administration approved a new, highly anticipated drug from Vertex Pharmaceuticals. The culmination of decades of work, Vertex’s Journavx is now cleared to treat the short-lived “acute” pain usually felt after an accident or a surgery. Vertex hopes to eventually get the drug approved for chronic pain as well, though clinical trials testing it in that setting have produced mixed results. Acute pain is often treated with a combination of acetaminophen, anti-inflammatory agents like ibuprofen and, if necessary, opioids, which pose an addiction risk because they act directly on the brain and stimulate pleasure centers. Despite the dangers, insurance companies, pharmacy managers and drugmakers like Purdue Pharma for years pushed for the use of opioids in pursuit of immense profits. The resulting overdose crisis has killed hundreds of thousands of people in the U.S. alone. Vertex is positioning its medicine as a valuable alternative to opioid-based therapies. A first-of-its-kind pill, Journavx, works by blocking a certain kind of pain-signaling protein found almost exclusively in nerve cells outside the brain and spine. It’s thought to not have addictive properties and, so far, human testing has shown it to be remarkably safe. In a statement, Jacqueline Corrigan-Curay, acting director of the FDA’s main drug review office, called the approval of Journavx an “important public health milestone in acute pain management”  She added that drugs like Vertex’s offer another treatment option for patients and “an opportunity to mitigate certain risks associated with using an opioid for pain.” Some experts caution it’s too early to know for sure whether Journavx is truly non-addictive. Still, that possibility is central to Vertex’s pitch. “I’m not going to use the word silver bullet, but [Journavx] is really, really compelling,” said Stuart Arbuckle, Vertex’s chief operating officer. “That’s how we are going to be presenting it to physicians and patients: Here’s a new treatment option, which we think … is the best of both worlds.” Arbuckle, who is overseeing the drug’s launch, said Vertex has been planning for this approval for “a number of years.” The company has amassed 150 staff to sell Journavx, which it priced at $15.50 per pill, or about $30 per day. Cost and patient access are concerns with most new medicines, but they can be especially prominent in the pain market due to the multitude of cheap generic options. According to Arbuckle, doctors and payers have questioned his team about those two issues more than anything else. 

For more information: https://tinyurl.com/mu8yjbe9

Hep C World News - Week of Feb 23, 2025

Many fatal overdose victims sought medical help the week before their deaths

Toronto, ON - Evidence suggests health-care providers are missing opportunities to connect with people in vulnerable moments, researcher tells Toronto Star. Inside Ontario hospitals and emergency rooms, the same scene has played out hundreds of times. A patient, advised they need medical care, decides to leave against a doctor’s advice. Within a week, they’ve died of an overdose. This is the grim picture painted by new research from the Ontario Drug Policy Research Network at St. Michael’s Hospital and Public Health Ontario, examining a staggering rise in accidental drug and alcohol-related deaths — up from an average of 4.5 deaths each day in 2018 to eight deaths daily in 2022.  Nearly a third of people who died were in hospital in-patient wards or emergency rooms within a week of their deaths, the researchers found. One in four patients who were admitted to hospital within their final week left before doctors believed they were ready — twice as many as four years earlier — as well as one in 10 patients in the ER. It’s a finding that caught investigator Tara Gomes off guard, with more people leaving than she expected. “That is an enormous number of people who are coming into our hospital system looking for some kind of help with their health-care needs and are leaving without getting that help,” Gomes said. Their findings build on previous reports that revealed one in five people who died from substance toxicity were treated in hospital for an overdose they survived in the year before death. To Gomes, the evidence suggests missed opportunities to connect with people in vulnerable moments and keep them linked to care that could prevent the worst outcomes. “Even when people are completing their care in these settings, there’s something missing in our ability to connect people to community services, to understand their needs, connect them to treatment or harm reduction programs to help prevent those deaths from happening.” There have been some promising new strategies lately, Gomes said, such as hospitals having addictions specialists available to consult on care such as advising an emergency room doctor prescribing methadone. But those kinds of services are still emerging and relatively uncommon, Gomes said. A changing street drug landscape has made responding more complex, she said. The new research shows an 186 per cent increase in the death rate involving three or more substances in just four years, as well as a 167 per cent rise in the death rate involving two substances and 75 per cent rise in the death rate attributed to a single drug or alcohol alone.

For more information: https://tinyurl.com/wu524a44

Hep C World News - Week of Feb 16, 2025

Influenza reaches epidemic threshold in New York

New York, NY - Influenza A (Unknown variety) positivity soars (yellow), while hospitalizations stand higher than past 3 years. The rise of unknown subtyping Flu A has led NY to issue new alert to subtype all Flu A immediately for bird flu. CDC & NY State is now recommending the immediate testing & subtyping of all hospitalized flu A cases & unknown/suspected flu cases—in order to identify human bird flu. This implies CDC believes avian flu has now crossed into wide community transmission. 

For more information:  https://nyc.gov/assets/doh/dow

Hep C World News - Week of Feb 9, 2025

Viral hepatitis elimination requires equitable public health approach

Geneva, Switzerland - Viral hepatitis is a major danger to public health. According to WHO’s 2024 Global Hepatitis Report, viral hepatitis deaths increased from 1.1 million in 2019 to 1.3 million in 2022, rates now similar to tuberculosis. Hepatitis B virus caused 83% of these deaths and hepatitis C virus 17%. Health disparities contribute to the persistence of viral hepatitis. High-impact interventions to prevent, diagnose and treat viral hepatitis exist, including vaccines and effective treatments for HBV and a cure for HCV. The COVID-19 pandemic further exposed the health disparities and inequities faced by underserved populations. To achieve viral hepatitis elimination, these inequities need to be faced head on. Hepatitis B virus causes 83% of viral hepatitis-related deaths. Source: NIAID  WHO has defined viral hepatitis elimination as a 90% reduction in new chronic infections and a 65% reduction in mortality when compared with 2015 baseline data. The most common hepatitis viruses with the greatest impact on public health are A, B, and C. HAV is the most common cause of acute viral hepatitis, with infection incidence strongly correlated to poor sanitation: Over 50% of all outbreaks are traced back to improper food handling and low socioeconomic conditions. HBV and HCV transmission can occur perinatally, through sexual contact or through injection use. An estimated 254 million people are living with HBV and 50 million with HCV. Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, Russia and Vietnam, collectively, shoulder nearly two-thirds of the global burden of HBV and HCV. In the United States, non-Hispanic Black people had the highest rate of acute HBV infection in 2022. Historically, people aged 30 to 59 years and men have had the highest rates of acute HBV infection. Chronic HBV infection followed a similar pattern of disparities, with highest rates of infection among non-Hispanic Asian/Pacific Islander people. Since 2010, those aged 20 to 49 years have consistently had the highest rates of acute HCV infection, mirroring fatal overdose data in the U.S. This underscores the need for targeted interventions across racial and ethnic populations, age groups and genders. One challenge hindering the lack of progress toward elimination of viral hepatitis is missed opportunities for vaccination. Safe and effective vaccines to prevent HAV and HBV are available. In 2011, the first vaccine to prevent hepatitis E infection was approved in China. HAV vaccines have been available for over 2 decades for those aged 12 months or older. Safe drinking water, sanitation and hygiene and outbreak control are other important HAV infection mitigation measures. In highly endemic countries, most are asymptomatically infected with HAV in childhood, which yields immunity in adulthood. HAV vaccination is not recommended in these countries because it may cause a “paradoxical increase in disease incidence in unvaccinated people,” according to WHO. In more developed HAV countries, outbreaks among men who have sex with men and people experiencing homelessness have contributed to subsequent vaccine shortages, given the sharp increases in vaccine demands. Bolstering vaccine supply stores, pre-vaccination screening for anti-HAV IgG in high-risk persons and using pediatric formulations with a single-dose strategy have been employed to improve vaccine availability. Several HBV vaccines are available worldwide. However, an estimated 45% of infants received a dose of HBV vaccine within 24 hours of birth among 115 countries with universal HBV birth-dose vaccination in 2022. Vaccine uptake varies by region, ranging from 18% in Africa to 80% in the Western Pacific among low- and middle-income countries. Most of the global burden of chronic HBV infection can be attributed to mother-to-child transmission of HBV peripartum or through horizontal transmission in early childhood. Scaling up HBV vaccination within 24 hours of birth is crucial. Additional HBV screening during pregnancy and subsequent tenofovir prophylaxis or universal antiviral prophylaxis when testing is not available are newer strategies to minimize transmission. Currently, there is no effective vaccine against HCV, although development of one could revolutionize HCV prevention. Implementation of adult vaccinations in settings where people with risk factors receive other services — such as refugee health centers, substance use disorder clinics, homeless organizations, HIV and STI clinics and correctional settings — will hasten vaccine coverage among adults who were not vaccinated against HBV during childhood. Preventing disease occurrence among adults will help decrease mother-to-baby vertical transmission. 

For more information: https://tinyurl.com/msjvmcw6

Hep C World News - Week of Feb 2, 2025

Overdose crisis enters dangerous new phase with ‘rhino tranq’ in drug supply

Philadelphia, PA - To address this evolving crisis, we must dramatically expand rapid access to treatments for addiction and harm reduction resources. A Kensington Hospital wound care outreach van welcomes patients in 2023. The authors write that deploying mobile treatment units to reach people where they are is one of the ways to treat the wave of medetomidine or "rhino tranq" that is involved in one in five fentanyl-related deaths in Philadelphia. After claiming more than 500,000 American lives over the course of two decades, the overdose crisis has entered an even deadlier phase. In Philadelphia-area intensive care units, doctors are now facing an unprecedented challenge that’s upending decades of medical protocols. A patient experiencing drug withdrawal now requires advanced critical care intervention — their blood pressure dangerously high, vomiting uncontrollable, mental status altered, and heart rate plummeting. Across the city, ICUs are adapting to a new reality: medetomidine, dubbed “rhino tranq” on the streets. Medetomidine — a powerful animal tranquilizer up to 200 times more potent than its predecessor, xylazine — has infiltrated the drug supply and silently become the dominant additive in Philadelphia’s fentanyl supply. According to the Philadelphia Medical Examiner’s Office, it is now present in 87% of the city’s fentanyl samples, transforming what was routine withdrawal management into critical care emergencies in hospitals. The emergence of medetomidine marks a dangerous new phase in the overdose crisis. First detected in Maryland in July 2022, it has now spread to major cities including Philadelphia. In May, Philadelphia documented 160 overdoses in just four days, with medetomidine detected in 46 overdose deaths. Six months later, in November, the city saw the prevalence of medetomidine surpass the prevalence of xylazine in the drug supply for the first time. And just last month, the Philadelphia Department of Public Health issued an alert about the rising drug-related morbidity and mortality from medetomidine. Naloxone, the opioid overdose reversal agent in Narcan, has no effect on medetomidine, write the authors.Astrid Riecken / The Washington Post The implications cannot be overstated. In comparison to xylazine, medetomidine produces withdrawal symptoms so severe they can be life-threatening. Patients experience intractable vomiting, hypertensive emergencies resistant to standard treatments, and complex cardiac presentations. Nearly one in five recent fentanyl-related deaths in Philadelphia now involve medetomidine, with users remaining sedated for at least three hours after exposure. Our health-care system is struggling to adapt. Standard withdrawal protocols have become insufficient. Our health-care system is struggling to adapt. Standard withdrawal protocols have become insufficient, with traditional assessment tools proving inadequate for these complex cases. Emergency departments and inpatient units find themselves utilizing patient beds typically reserved for intensive care, and ICUs are facing increasing strain in allocating resources to these patients. The situation is also complicated because naloxone, the opioid overdose reversal agent, has no effect on medetomidine. Without systemic changes, we risk overwhelming our ICUs while failing to adequately treat patients. Tabs of buprenorphine, a drug which controls heroin and opioid cravings, are photographed in Greenfield, Mass., in 2018. To address this evolving crisis, we need a three-pronged approach. First, we must dramatically expand rapid access to treatments for addiction and harm reduction resources. This means implementing 24/7 buprenorphine or methadone initiation in emergency departments, deploying mobile treatment units to reach people where they are, and increasing the distribution of key resources such as naloxone and safe syringe exchange options. The evidence is clear: early intervention with appropriate medication saves lives. 

For more information: https://tinyurl.com/bp4v6dbv

Hep C World News - Week of Jan 26, 2025

New lawsuit challenges Ontario’s decision to prohibit safe consumption services

Toronto, ON - Critics say Ontario’s plan to replace supervised consumption sites with HART Hubs will exacerbate harms to drug addicts and strain the health-care system The operator of a Toronto overdose prevention site is challenging Ontario’s decision to prohibit 10 supervised consumption sites from offering their services. In December, Neighbourhood Group Community Services and two individuals launched a constitutional challenge to Ontario legislation that imposes 200-metre buffer zones between supervised consumption sites and schools and daycares. The Neighbourhood Group will be forced to close its site in Toronto’s Kensington Market as a result. In its court challenge, the organization is arguing site closures discriminate against individuals with “substance use disabilities” and increase drug users’ risk of death and disease. The challenge is the latest sign of growing opposition to Ontario’s decision to either shutter supervised consumption sites or transition them into Homelessness and Addiction Recovery Treatment (HART) Hubs. The hubs will offer drug users a range of primary care and housing solutions, but not supervised consumption, needle exchanges or the “safe supply” of prescription drugs. Critics say the decision to suspend supervised consumption services will harm drug users and the health-care system. “We’re very happy that the HART Hubs are being funded,” said Bill Sinclair, CEO of Neighbourhood Group Community Services. “They’re a great asset to the community.” “[But] we want HART Hubs and we want supervised consumption sites.” On Thursday, the Ontario government announced that nine of the 10 supervised consumption sites located near centres with children would transition into HART Hubs. 

For more information: https://www.breakingneedles.com

Hep C World News - Week of Jan 19, 2025

Nearly a third of fatal overdose victims sought health care the week before their deaths

Toronto, ON - Evidence suggests health-care providers are missing opportunities to connect with people in vulnerable moments, researcher tells Toronto Star. Inside Ontario hospitals and emergency rooms, the same scene has played out hundreds of times. A patient, advised they need medical care, decides to leave against a doctor’s advice. Within a week, they’ve died of an overdose. This is the grim picture painted by new research from the Ontario Drug Policy Research Network at St. Michael’s Hospital and Public Health Ontario, examining a staggering rise in accidental drug and alcohol-related deaths — up from an average of 4.5 deaths each day in 2018 to eight deaths daily in 2022.  Nearly a third of people who died were in hospital in-patient wards or emergency rooms within a week of their deaths, the researchers found. One in four patients who were admitted to hospital within their final week left before doctors believed they were ready — twice as many as four years earlier — as well as one in 10 patients in the ER. It’s a finding that caught investigator Tara Gomes off guard, with more people leaving than she expected. “That is an enormous number of people who are coming into our hospital system looking for some kind of help with their health-care needs and are leaving without getting that help,” Gomes said. Their findings build on previous reports that revealed one in five people who died from substance toxicity were treated in hospital for an overdose they survived in the year before death. To Gomes, the evidence suggests missed opportunities to connect with people in vulnerable moments and keep them linked to care that could prevent the worst outcomes. “Even when people are completing their care in these settings, there’s something missing in our ability to connect people to community services, to understand their needs, connect them to treatment or harm reduction programs to help prevent those deaths from happening.” There have been some promising new strategies lately, Gomes said, such as hospitals having addictions specialists available to consult on care such as advising an emergency room doctor prescribing methadone. But those kinds of services are still emerging and relatively uncommon, Gomes said. A changing street drug landscape has made responding more complex, she said. The new research shows an 186 per cent increase in the death rate involving three or more substances in just four years, as well as a 167 per cent rise in the death rate involving two substances and 75 per cent rise in the death rate attributed to a single drug or alcohol alone.

For more information: https://tinyurl.com/wu524a44

Hep C World News - Week of Jan 12, 2025

Patient navigator services needed to link people to hepatitis C care after jail 

Montreal, PQ - A team of researchers at McGill University in Montreal conducted a study to assess which issues acted as barriers to or facilitators of HCV care after people were released from prison. The researchers interviewed 10 men from Quebec’s largest provincial prison, L’Établissement de détention de Montréal (EDM). These men had chronic HCV, and they all wanted and received patient navigators to help them with post-release care. Interviews were conducted between November 2022 and July 2024. A brief average profile of participants upon entering the study (after release from prison) was as follows:

• age – 54 years (ranging from 32 to 69)
• 50% had completed high school
• age when first incarcerated – 20 
• history of injecting drugs – 90%
• previously treated for HCV – 80%
• drug use after release from prison – 8 used non-injection drugs and 1 injected drugs
• unstable housing – 8 participants

Researchers divided their findings into different themes; we will largely reproduce these themes in our report. According to the researchers, “for most participants, support from healthcare providers helped improve their health literacy and acted as facilitators to linkage to care.” They added: “Overall, most participants had a basic understanding of the virus, its modes of transmission, and long-term consequences. Most participants demonstrated an understanding of HCV as a virus which affected the liver and which was primarily transmitted through blood, leading to potentially severe outcomes such as cirrhosis if untreated. This basic understanding better equipped participants to link to HCV care post-release.” Some participants underscored the presence of educational materials at clinics and shelters that helped them learn about HCV. One participant commented on the value of educational materials, saying: “Knowing that there are options available and that I don’t have to face this for a long time makes me feel like I have more time. It motivated me to go through all the steps [involved in care and treatment].” The researchers noted that several participants had difficulty accessing information because they did not have regular internet access or they had issues with health literacy. Some participants disclosed that they were not initially motivated to engage in HCV care and treatment because they assumed that their symptoms had other causes or they had competing priorities, such as finding stable housing. However, multiple participants disclosed that deteriorating health forced them to become engaged with care. One participant stated: “I had been feeling very unwell over the past few months, feeling tired, [enduring] abdominal pain, and a general sense of malaise. Initially I brushed it off, figured it was because of my conditions of living on the streets. But, as time passed, this feeling didn’t stop and even worsened. I thought this was going to be the rest of my life…I started to think something was wrong, but I didn’t want to tell anybody. It set off alarm bells in my mind.” Another participant stated: “I knew that seeking hepatitis C care was essential not only for my own well-being but also to break the cycle of illness and pain that had plagued me for so long.” One person told the researchers: “I wanted to show myself and others that I could turn things around. Getting rid of this disease was one of those steps.” Overall, the researchers found that participants had multiple reasons for getting HCV care and treatment, including “to improve their health, prevent transmission and overcome their past—as it relates to breaking free from repetitive cycles of illness, pain and substance use.” 

For more information: https://tinyurl.com/53dbeett

Hep C World News - Week of Jan 5, 2025

Gut and Oral Microbiomes: Keys to Cirrhosis Outcomes

London, UK - One in five patients hospitalised with cirrhosis succumbs to the condition, highlighting its grave prognosis. Infections, predominantly from multidrug-resistant organisms (MDROs), play a critical role in acute decompensation and acute-on-chronic liver failure (ACLF). Bacterial breaches in immune defences and ineffective clearance exacerbate this risk, placing antimicrobial therapy at the heart of treatment strategies. However, antimicrobial resistance presents escalating challenges, particularly in Europe and globally, necessitating innovative approaches. Cirrhosis-associated immune dysfunction (CAID) heightens infection susceptibility through low-grade systemic inflammation and gut-liver axis alterations, including microbiome disruption and increased intestinal permeability. Gut dysbiosis, characterised by imbalances in microbial communities, fosters MDRO proliferation and worsens clinical outcomes. Emerging evidence underscores the interplay between gut and oral microbiomes, with microbial translocation from the mouth to the gut linked to decompensation. For instance, periodontitis, present in up to 68% of cirrhotic patients, has been implicated in worsening liver function. Intriguingly, periodontal therapy may mitigate systemic inflammation and improve disease markers. Advances in shotgun metagenomic sequencing (SMGS) have enabled deeper insights into microbiome changes. Studies reveal reduced microbial diversity in the oral and gut niches as cirrhosis progresses, with pathogenic bacteria such as Enterococcaceae and Veillonellaceae gaining dominance. These shifts correlate with functional alterations, including disrupted metabolic pathways and increased ammonia production, a contributor to hepatic encephalopathy. The resistome – genes conferring antimicrobial resistance – represents a critical area of study. Gut ARGs, amplified by inflammation and dysbiosis, pose significant threats, while the oral resistome appears more stable. These findings suggest selective pressures beyond antibiotic use, driven by disease severity. Future research must adopt a longitudinal, multicentric approach to disentangle causative mechanisms and explore precision therapies targeting both microbiomes. Non-antibiotic treatments, including nutritional and periodontal interventions, offer promising pathways. Understanding these microbiome dynamics is vital for improving outcomes in cirrhosis, especially amidst the rising tide of MDRO infections. 

For more information: https://tinyurl.com/mun67hfp

Hep C World News - 2024

Hep C World News - Week of Dec 29, 2024

UK to open its first safe drug consumption room amid soaring deaths

Glasgow, Scotland - The UK’s first official facility for consuming illegal drugs opens in Glasgow within a month, reported the Guardian newspaper. This move, that experts and campaigners hope will bring major changes to drug policy, reported. The pioneering “safer drug consumption facility”, named the Thistle, was due to open on Hunter Street, in the city’s east end, earlier this year but was delayed by building tests. It has been made possible after Scotland’s lord advocate said it would not be in the public interest to prosecute anyone using it. Plans for a facility in Glasgow were first proposed a decade ago in response to an HIV outbreak among people injecting drugs but were repeatedly blocked by the Home Office under the Conservatives, who said such a service would contravene the Misuse of Drugs Act 1971. But Glasgow Labour and Coopera­tive MSP Paul Sweeney, who has volunteered with a safe consumption van in the city designed to test the legal framework, told the Observer he had had encouraging conversations with the UK crime and policing minister, Diana Johnson. He said she is “open-minded and supportive, and interested in looking at the evidence from Glasgow to inform the Home Office approach”. A government spokesperson said: “Every death from drug misuse is a tragedy for those who have lost their lives, their families and for the wider community. While we have no plans to change UK drug laws, through our mission-driven government, we will take preventative public health measures to tackle the biggest killers in society – including drug misuse – and support people to live longer, healthier lives.” Niamh Eastwood, the executive director of drugs charity Release UK, said it was “shameful these facilities are not being opened across the UK”. “The UK government must act to allow the establishment of drug consumption rooms across the UK, In the meantime, local areas can respond to this crisis by seeking police signoff to allow for the operation of these sites.” she added. The Thistle will allow people to inject illegal drugs bought elsewhere in a hygienic, supervised environment where trained professionals can respond to injury and overdose, as well as offering wraparound care and signposting to other services. It will open 365 days a year, from 9am to 9pm and is situated close to a number of known public injecting sites. There are more than 100 safe consumption facilities across the world and none has ever recorded a death. “The logic is really simple – public injecting is dangerous because it’s extremely unhygienic and can lead to infection and injury, and in some cases death,” said Andrew McAuley, public health professor at Glasgow Caledonian University and a NHS consultant in Glasgow. Known injection sites in Glasgow city centre include alleyways, car parks and bin sheds, which are often dark, isolated and dirty, he said. “There’s also the environmental hazard of discarded drug-related litter, like needles and syringes, in places where people are working and living,” McAuley said. “Having a room effectively moves those hazards from the streets into a controlled, clean and safe environment for everybody.” The Thistle opens amid what has been called a drug deaths emergency in Scotland, with Glasgow named Europe’s drug deaths capital. Figures show 1,172 people died in 2023, almost a quarter of them in Glasgow. But those involved emphasise the Thistle was designed to meet the needs of a specific community – people, many of them homeless, publicly injecting in the city centre – and other interventions are needed to bring drug death figures down. “This service will hopefully be very effective … but it’s not a silver bullet,” said Saket Priyadarshi, associate medical director for drug and alcohol recovery services in NHS Greater Glasgow and Clyde. “We’re not relying on one intervention but a whole package of treatment and care.” This includes crisis outreach services, residential rehabilitation and a national programme to distribute naloxone, used to reverse the effects of opioid overdose, he said. Other UK cities have expressed interest in the Thistle, Priyadarshi added. “The UK for a while had a fantastic reputation around harm reduction and drug treatment, but undoubtedly in recent years we’ve lagged behind. “It’s very exciting to be opening the UK’s first drug consumption facility, but it’s tempered by the realisation we are probably significantly late compared with other places. It’s a shame it has taken us so long to get here,” he said. 

For more information: https://tinyurl.com/5c7tn9se

Hep C World News - Week of Dec 22, 2024

Drug Dealers Have Moved on to Social Media

London, UK The marketing of illegal drugs on open platforms is “gaining prominence,” authorities note, while the number of drug transactions on the dark web has decreased in recent years. For every illegal drug, there is a combination of emojis that dealers and consumers use to evade detection on social media and messaging platforms. Snowflakes, snowfall, and snowmen symbolize cocaine. Love hearts, lightning bolts, and pill capsules mean MDMA, or molly. Brown hearts and dragons represent heroin. Grapes and baby bottles are the calling cards for codeine-containing cough syrup, or lean. The humble maple leaf, meanwhile, is the universal symbol for all drugs.Bottom of Form The proliferation of open drug dealing on Instagram, Snapchat, and X—as well as on encrypted messaging platforms Telegram and WhatsApp—has transformed the fabric of illegal substance procurement, gradually making it more convenient, and arguably safer, for consumers, who can receive packages in the mail without meeting people on street corners or going through the rigmarole of the dark web. There is no reliable way to gauge drug trafficking on social media, but the European Union Drugs Agency acknowledged in its latest report on the drivers of European drug sales that purchases brokered through such platforms “appear to be gaining in prominence.” Initial studies into drug sales on social media began to be published in 2012. Over the next decade, piecemeal studies began to reveal a notable portion of drug sales were being mediated by social platforms. In 2021, it was estimated some 20 percent of drug purchases in Ireland were being arranged through social media. In the US in 2018 and Spain in 2019, a tenth of young people who used drugs appear to have connected with dealers through the internet, with the large majority doing so through social media, according to one small study. Some dealers these days are even brazen enough to boost their posts and pay for sponsored advertising. “Mushrooms and marijuana used to be hard to get and now they’re being marketed to me in beautiful packaging on Instagram,” says one 34-year-old in Austin, Texas, whom WIRED spoke to. Dealers ran hundreds of paid advertisements on Meta platforms in 2024 to sell illegal opioids and what appeared to be cocaine and ecstasy pills, according to a report this year by the Tech Transparency Project, and federal prosecutors are investigating Meta over the issue. “You’re seeing a more sophisticated commoditization of the available marketplaces,” says Adam Winstock, a British consultant psychiatrist and addiction medicine specialist who is also the founder of the Global Drug Survey. The current drug-using younger generation are entirely used to getting everything online, he adds, reflecting the increasing integration of social media in people’s lives. “It’s convenient, [and] there’s less chance of violence.” There are heightened concerns over the presence of super-strength opioids like fentanyl in drugs. But despite some contaminated pills having lethal effects on those who purchased them on the internet, Winstock says that drugs purchased through online networks are subject to “potentially better quality control”—with Telegram channels devoted to discussing the quality of drugs purveyed by certain dealers, and Amazon-style feedback sections within some vendors’ stores. “The question is where in the food chain that they’re cut,” Winstock says. 

For more information: https://tinyurl.com/5m8m7nr4

Hep C World News - Week of Dec 15, 2024

Older age, not comorbidity, linked to worse survival in hepatocellular carcinoma

Dallas, TX - Older age but not high comorbidity burden was significantly associated with overall survival among patients with hepatocellular carcinoma, even those with early-stage disease, according to study results. “Patient characteristics, including age and comorbidity, can impact treatment eligibility and competing risks of mortality, thereby limiting the benefits of cancer screening,” Mounika Kanneganti, MD, an internal medicine resident at UT Southwestern Medical Center, and colleagues wrote in Clinical Gastroenterology and Hepatology. “To date, age and non-liver comorbidity have not been included in HCC screening recommendations, although one study suggested HCC screening was no longer cost-effective in patients [older than] 70 years with hepatitis C after sustained virological response.” They continued, “Further, most studies have focused on chronological age without consideration of comorbidity burden.” In a retrospective cohort study, Kanneganti and colleagues investigated the impact of age and comorbidity burden on tumor stage, receipt of curative treatment and overall survival in HCC. They enrolled 2,002 patients (median age, 61.3 years; 75.8% men) diagnosed with HCC between January 2010 and February 2023 at two large health centers from the North American Liver Cancer Consortium. More than half of the population (56.9%) had liver disease etiology of hepatitis C virus, followed by alcoholic liver disease (16.3%) and metabolic dysfunction-associated steatotic liver disease (11.8%), and 20.6% had early-stage tumor burden. The most common comorbidities included a history of heavy alcohol use (53%), diabetes (29%) and peripheral vascular disease (10.1%); patients aged 65 years and older had higher comorbidity burden compared with younger patients (Charlson Comorbidity Index = 6 vs. 4). During a median follow-up of 10.6 months, 30.4% of patients underwent curative treatment, which included a higher proportion of older vs. younger patients (36.8% vs. 27.7). Median survival was 15.7 months overall and 56.5 months among those with early-stage HCC. Younger patients demonstrated a higher median survival overall (20 months vs. 14 months), as well as when categorized by early-stage disease (65 months vs. 49 months) and receipt of curative treatment (113 months vs. 60 months). While adjusted analyses showed receipt of curative treatment was associated with high comorbidity burden (OR = 1.47; 95% CI, 1.03-2.1) but not older age (OR = 0.93; 95% CI, 0.7-1.23), overall survival was significantly associated with older age (HR = 1.25; 95% CI, 1.06-1.47) but not high comorbidity burden (HR = 0.92; 95% CI, 0.77-1.09). Older age remained associated with worse survival among those with early-stage disease (HR = 1.99; 95% CI, 1.45-2.73), as well as those who received curative treatment (HR = 1.52; 95% CI, 1.1-2.1). “Older age but not comorbidity burden is associated with worse overall survival in patients with HCC, including those with early-stage HCC,” Kanneganti and colleagues wrote. “Continued studies are needed to evaluate the intersection of age and comorbidity on curative treatment eligibility and prognosis.” 

For more information: https://tinyurl.com/4bjpznfd

Hep C World News - Week of Dec 8, 2024

Decriminalisation key as Australian doctors push for drug policy reforms 

Sydney, Australia - Drug decriminalisation, regulated cannabis trials, more pill testing and syringe programs are on the list of health reforms demanded by Australia's largest specialist medical society. The Royal Australasian College of Physicians (RACP) is the collective voice of more than 30,000 specialists across Australia and New Zealand, from 33 different specialties including addiction medicine, public health, and general medicine. By other professionals in the sector, the RACP is considered elite, conservative, and influential. The RACP disclosed its new position statement exclusively ahead of the concluding sessions of the NSW Drug Summit in Sydney. Its previous Illicit Drugs Policy is almost 20 years old. "We think it's time we have a whole of society discussion about where we want to be in this area, and where we actually want to put our funds to prevent people from getting into those cycles of ill health, and popping in and out of institutions and incarceration," RACP President Dr Jennifer Martin told 7.30. The society's position statement will act as a framework to lobby governments and organisations across Australia, outlining the 'rationale and evidence for a health-focused approach to inform policy development'. It focuses on drugs which have been classified as illicit in most jurisdictions. "These include cannabis, heroin and other illicit opioids, cocaine, amphetamine-type stimulants, other illicit stimulants, non-prescribed sedative drugs, hallucinogens and empathogens and some prescription medicines obtained illicitly," Dr Martin said. The RACP outlined 17 calls to action under the banner of harm reduction. They include 'further steps to decriminalize the use of drugs and possession for personal use' across drug classes, communities; establishing trials of regulated cannabis markets; expanding drug checking services and pill testing trials; more free syringe programs and medically supervised injecting centres. "Importantly, we recognize that both the use of drugs and our government's response to the use of drugs can cause harm and that stigma surrounding drug use can have profound and far-reaching consequences for individuals who use drugs," the position paper reads. 'Won't be going down that path' While a spokesperson for Federal Health Minister Mark Butler said the measures are "matters for state and territory governments", the NSW Minns government has already struck down one of the RACP's key policies. "The premier's made some things clear around decriminalisation, that we probably wouldn't be going down that path per se," NSW Health Minister Ryan Park told 7.30. "What we'll be doing is working out how we can do things better. Can we improve what we're already doing? And then what are the opportunities to do things in a more collective way going forward." It's not the first time decriminalisation has been flatly rejected. It was also a key recommendation of the NSW Special Commission of Inquiry into the Drug Ice, in 2018. Dan Howard was the Commissioner of the Inquiry, and told 7.30 "it's just madness to leave the policies as they are." "I recommended a diversion scheme as a fallback, if the government didn't have the courage to decriminalize simple use and possession," he said. 

For more information: https://tinyurl.com/3b9k3daw

Hep C World News - Week of Dec 1, 2024

Despite progress fighting the overdose epidemic, outdated policies are ‘costing lives’

Chicago, IL - Drug overdose deaths decreased slightly in 2023 compared with the previous year but still remain at a near-historic high, according to an AMA report. The slim reduction in drug-related mortality comes despite a more than 50% decrease in the number of opioid prescriptions over the last 12 years. The AMA’s 2024 Opioid Overdose Epidemic report highlights the significant progress achieved in reducing opioid prescriptions, in addition to increasing naloxone availability. However, the report also captures challenges that remain obstructive of efforts to effectively address the ongoing crisis, such as barriers to accessing buprenorphine and other medications for opioid use disorder. “Half-measures and outdated policies are costing lives, and we urge policymakers to act. With thousands of families and communities devastated by overdose deaths, the time for incremental change has passed,” Bobby Mukkamala, MD, AMA president-elect, said in a press release. “We need unwavering commitment to expand access to lifesaving medications, enforce parity laws, and address the glaring gaps in harm reduction. We cannot stand by as outdated policies and insurance barriers prevent patients from accessing evidence-based care.” According to the report, opioid prescriptions decreased from 260.5 million in 2012 to 125.9 million in 2023 for a reduction of 51.7%, while decreases at the state-level during that time ranged between 36% and 68%. These reductions in prescriptions did not result in substantial decreases in drug-related mortality, however, with 107,543 overdose deaths occurring in 2023. Meanwhile, state prescription drug monitoring programs were used more than 1.4 billion times in 2023, up from 61 million in 2014. The AMA noted that buprenorphine prescriptions dispensed from retail pharmacies plateaued at over 15.6 million in 2023, likely due to factors such as pharmacy reluctance to stock the medication, concerns over suspicious order reporting requirements from the U.S. Drug Enforcement Agency (DEA) and delays in care because of the restrictions. In contrast, naloxone prescriptions from retail pharmacies have continued to grow, rising from around 555,000 in 2018 to almost 2.2 million in 2023 for an increase of 291.5%.

For more information: https://tinyurl.com/ej8f26pd

Hep C World News - Week of Nov 24, 2024

Tapered Steroid Dosing Safe, Effective in Severe Alcohol-Associated Hepatitis

San Diego, CA - Tapering doses of corticosteroids was safer than, and just as effective as, a fixed dose in patients with severe alcohol-associated hepatitis, a randomized trial showed. Patients who received a tapered dose of prednisolone starting at 40 mg and reduced by 10 mg weekly over the course of 4 weeks compared with a fixed dose of prednisolone 40 mg for 4 weeks experienced fewer infections (25 vs 42) and were hospitalized less frequently (33% vs 44.1%) at 90 days, reported Anand Kulkarni, MBBS, of the Asian Institute of Gastroenterology in Hyderabad, India. Tapering prednisolone also reduced the risk of all-cause adverse events compared with a fixed dose (48.8% vs 60%). Frequent adverse events included acute kidney injury (18.9% vs 26.8%, respectively), hepatic encephalopathy (6.3% vs 11.8%), hyperglycemia (3.9% vs 7.1%), and hematochezia (4.7% vs 6.3%). Tapering had no effect on overall survival, nor on Model for End-Stage Liver Disease (MELD) score, Kulkarni said during a late-breaking abstract session at the American Association for the Study of Liver Diseases annual meeting in San Diego. Severe alcohol-associated hepatitis has a mortality rate of 20%-30% at 90 days. While the use of corticosteroids has been standard of care in these patients, infection is a major concern. According to Kulkarni, there have been no large, randomized trials assessing the optimal dose of corticosteroids, "and it is unknown whether stepwise tapering of corticosteroids reduces the risk of infection." This multicenter, open-label trial included 254 patients from four Indian centers and one Canadian center who were randomized 1:1 to the tapering group or the fixed dose group. Across the two groups, mean age was 41-42 years, 98-99% were men, and mean MELD score was 25.3 to 26. The average daily corticosteroid dose was 28.4 mg in the tapered dose group and 40.8 mg in the fixed dose group, and the proportion of steroid responders (defined as a Lille's score <0.45) was similar between groups (82.5% vs 80.3%). Fifty-five percent of patients in the tapered group received prophylactic antibiotics during corticosteroid therapy compared with 66% of the fixed dose group. In both groups, the most common type of infection was lung infection, followed by urinary tract infections, and median time to infection was 30 days. Average durations of hospitalization were 5.44 days in the tapered group and 6.31 days in the fixed dose group. The mortality rate at day 90 was 13.4% in the tapering group versus 16.5% in the fixed dose group, with the most common cause of death being sepsis with multiple organ failure in both groups. The mean MELD scores at day 90 were 16 in the tapering group and 17 in the fixed dose group, and the percentages of patients with a MELD score <17 at day 90 were 58.9% and 56.6%, respectively -- both insignificant differences. 

For more information: https://tinyurl.com/y227bj33

Hep C World News - Week of Nov 17, 2024

Implantable device may prevent death from opioid overdose

St. Louis, Missouri - The opioid epidemic claims more 70,000 lives each year in the U.S., and lifesaving interventions are urgently needed. Although naloxone, sold as an over-the-counter nasal spray or injectable, saves lives by quickly restoring normal breathing during an overdose, administrating the medication requires a knowledgeable bystander—limiting its lifesaving potential. A team from Washington University School of Medicine in St. Louis and Northwestern University in Chicago has developed a device that may rescue people from overdose without bystander help. In animal studies, the researchers found that the implantable device detects an overdose, rapidly delivers naloxone to prevent death and can alert emergency first responders. "Naloxone has saved many lives," said Robert W. Gereau, Ph.D., the Dr. Seymour and Rose T. Brown Professor of Anesthesiology and director of the WashU Medicine Pain Center. "But during an overdose, people are often alone and unable to realize they are overdosing. If someone else is present, they need access to naloxone—also known as Narcan—and need to know how to use it within minutes. We identified an opportunity to save more lives by developing a device that quickly administers naloxone to at-risk individuals without human intervention." Prescription opioids—such as oxycodone—have helped people manage the physical and mental challenges of daily debilitating pain. But the addictive properties of painkillers can lead to their misuse and abuse, which are among the driving forces behind the opioid epidemic. In addition, cheap and easy-to-access synthetic drugs—fentanyl, for example—have flooded the illicit market. Such ultrapotent drugs have accelerated the rise in overdose deaths in the U.S. and were responsible for roughly 70% of such deaths in 2023. The researchers worked with experts in engineering and material sciences led by John A. Rogers, Ph.D., a professor of materials science and engineering, biomedical engineering and neurological surgery at Northwestern University, to develop a device—the Naloximeter—that uses a drop in oxygen levels as a signal for a potential overdose. Overdosing on opioids leads to slow and shallow breathing. Minutes after the drugs begin to impact respiratory function, breathing stops. Implanted under the skin, the Naloximeter senses oxygen in the surrounding tissues, sending a warning notification to a mobile application if the levels drop below a threshold. If the user doesn't abort the rescue process within 30 seconds, the device releases stored naloxone. The researchers implanted the device in the neck, chest or back of small and large animals. The device detected signs of overdose within a minute of dropping oxygen levels, and all animals fully recovered within five minutes of receiving naloxone from the devices. Naloxone displaces harmful opioids from receptors on the surface of brain cells, altering the cells' activity. But the drug doesn't stick around; when the opioids reoccupy and reactivate the receptors, overdose symptoms can return. To provide additional support, the device relays an emergency alert to first responders. "An additional benefit of calling first responders is that it helps people re-engage with health-care providers," said Jose Moron-Concepcion, Ph.D., the Henry E. Mallinckrodt Professor of Anesthesiology at WashU Medicine and an author on the study. "We want to save people from dying from an overdose and also reduce harm from opioids by helping people access the resources and treatments to prevent future overdoses from occurring." The researchers were awarded a patent—with some help from the Office of Technology Management at WashU—to protect the intellectual property of the device. They are evolving the technology while also looking for industry partners in preparation for deployment on a larger scale and testing of the device in clinical trials with people. "The Naloximeter is a proof-of-concept platform that isn't limited to the opioid crisis," said Joanna Ciatti, a graduate student in Rogers' lab. "This technology has far-reaching implications for those threatened by other emergent medical conditions such as anaphylaxis or epilepsy. Our study lays important groundwork for future clinical translation. We hope others in the field can build off of these findings to help make autonomous rescue devices a reality." 

For more information: https://tinyurl.com/yxk5pstv

Hep C World News - Week of Nov 10, 2024

Estimating the effects of closing supervised consumption in Toronto

Toronto, ON - Supervised consumption sites have a strong evidence base for improving the health of people who use drugs, but the service remains politically controversial. The Government of Ontario has announced plans to close five of 10 sites in Toronto by March 2025, and another site is likely to close after its lease expires. This report estimates the impact of site closures on potential and actual use of supervised consumption sites. Researchers analyzed data under varying assumptions of how many sites will remain open and each supervised consumption site’s service radius (the distance clients would travel to access services, analyzed at 500, 1000, and 2000m). This study used administrative health data, data reported by supervised consumption sites to the Ontario Ministry of Health, and data reported directly by supervised consumption site operators to estimate; The number of people who use opioid and stimulant drugs in Toronto, where they were located, and how many would lose potential access to supervised consumption sites; The number of people who currently use supervised consumption sites; The number of current clients who would lose access or shift their use to a different supervised consumption site; The extra capacity required to address service losses What the researchers found is that each month, 636 people (47% of supervised consumption site current clients) would lose access if six sites close in Toronto. These estimates will change depending on how many sites stay open, how far people are willing to travel to go to an alternative site if their preferred site closes, and how much capacity sites that remain open will have to accommodate new clients. The remaining supervised consumption sites will be more than 500m from where over 90% of people who use opioids or stimulants are located in Toronto. The announced closures of supervised consumption sites have the potential to decrease access to an important health service for people who use drugs. This is the first analysis on how large this impact will be in Toronto. Currently, supervised consumption sites are accessible to only a small minority of people who use opioids and stimulants, and closing existing sites would exacerbate this disparity. If sites close, many clients will lose access, and sites that remain open would need to expand capacity considerably. Even with large increases in capacity among sites that remain open, many current clients will remain very distant from an open supervised consumption site and are therefore likely to lose access. This report underscores the urgency of reconsidering the planned supervised consumption site closures. Understanding how many people are affected is important for the ongoing policy discussion amongst decision makers. 

For more information: https://odprn.ca/research/publications/closingscs_toronto/

Hep C World News - Week of Nov 3, 2024

This one important step can reduce opioid-related deaths 

Atlanta, GA - To reduce some people’s risks of overdosing, you can encourage patients to keep their prescription opioids safe and secure, so that they do not fall into the wrong hands. Additionally, encourage patients to properly get rid of any prescription medications that are expired, or that you no longer recommend they take. The overdose crisis continues to devastate the nation, with almost 100,000 provisional drug overdose deaths being reported in the United States in the last 12 months. According to reports by the Centers for Disease Control and Prevention (CDC), yearly drug overdose deaths more than doubled between 2015 and 2023, when numbers hit a peak of about 112,000 reported deaths. Now in 2024, graphs of overdose death numbers show a steep decline. But while trends appear more hopeful than before, the US is nowhere close to being out of the danger zone. While various medications can be responsible for drug overdoses, many people who die from drug overdoses die from using opioids, and/or developing opioid use disorder (OUD). Some people who develop OUD may have purchased drugs illegally from elicit sellers or have first experienced opioids through a doctor’s prescription—such as prescribed pain medication. Other people who develop OUD may have also been exposed to opioids through another person’s prescription—such as a family member or friend who has the medication in their household. Studies show that when someone in a household has an opioid prescription, there is an increased chance of about 60% of someone else in the household overdosing on opioids—even if the other people do not have an opioid prescription of their own. Further, according to the National Institute on Drug Abuse (NIDA), 80% of people who use heroin used prescription opioids first.  To bring overdose rates down even further, some experts stress the urgency of securing prescription opioids in households—and making sure they don’t fall into the wrong hands. They encourage doctors like yourself to inform patients of the importance of keeping their medications away from other household members, like children, and properly disposing of any prescription medications they are no longer using. 

For more information: https://tinyurl.com/3vj23yrd

Hep C World News - Week of October 27, 2024

Hispanic, Asian populations in US at highest risk for alcohol-associated liver disease

Richmond, Virginia - Significant differences in alcohol use, alcohol-related mortality and liver transplant rate by race and ethnicity underscore the need for “tailored approaches to managing” alcohol-related liver disease in the U.S., according to a researcher. “Previous research has highlighted that outcomes in ALD can differ significantly among racial and ethnic groups and we have experienced the same in our clinical practice,” Juan Pablo Arab, MD, FRCPC, study author and director of alcohol sciences at Stravitz-Sanyal Institute of Liver Disease and Metabolic Health at Virgina Commonwealth University, told Healio. “However, a comprehensive understanding of how these disparities affect each stage of ALD across various populations has been lacking. “This study aimed to address these gaps using nationally representative databases, providing insights into how social and biological health determinants shape these disparities.” Arab and colleagues conducted a retrospective study of adults from 2011 to 2018 using National Health and Nutrition Examination Survey, National Inpatient Sample (NIS) and United Network for Organ Sharing (UNOS) databases to compare alcohol use, alcohol-associated liver disease (ALD) prevalence and mortality and LT rate among patients with ALD-related cirrhosis. Of 39,165 interviewees from NHANES (61.2% non-Hispanic white, 17.4% Hispanic, 12.1% Black, 5.4% Asian and 3.9% other), Black individuals had the highest daily alcohol consumption (11.6 g/day), while heavy episodic drinking was highest among Hispanic individuals (33.5%). From this overall population, 2,125 individuals met ALD criteria. According to multivariate analyses, Hispanic ethnicity was independently associated with higher ALD prevalence (OR = 1.4; 95% CI, 1.1-1.8), as was Asian ethnicity (OR = 1.5; 95% CI, 1.1-2), compared with non-Hispanic white ethnicity. Black individuals had the lowest prevalence of ALD (OR = 0.7; 95% CI, 0.6-0.9), despite the highest consumption. When analyzing 121,683 hospitalizations using NIS data, the researchers reported that Hispanic individuals had lower risk for inpatient ALD-related mortality (OR = 0.83; 95% CI, 0.73-0.94). “Hispanic patients hospitalized for decompensated cirrhosis had a higher prevalence of hepatocellular carcinoma but a lower mortality rate per hospitalization,” Arab said. In addition, of 98,000 patients listed for transplant in the UNOS database, there were “significant disparities in LT access,” he noted, with Hispanic patients (HR = 0.85; 95% CI, 0.78-0.92) and Asian women (HR = 0.4; 95% CI, 0.26-0.62) experiencing lower likelihood of transplant. “These findings highlight the need for more tailored approaches to managing ALD in diverse populations,” Arab told Healio. “Recognizing that certain racial and ethnic groups are at higher risk for ALD or face barriers in accessing life-saving treatments like liver transplantation can inform public health strategies. Implementing culturally and ethnically sensitive screening, treatment interventions and policies could help reduce these disparities and improve outcomes for vulnerable populations.” He continued: “Further research is necessary to better understand the underlying factors contributing to these disparities including genetic, socioeconomic and health care access-related influences.” 

For more information: https://tinyurl.com/2p9fhjjv

Hep C World News - Week of October 20, 2024

Fatal drug overdose deaths down as much as 10%, although reasons why remain unclear

Chapel Hill, NC - Fatal and nonfatal drug overdoses experienced “unprecedented” decreases of 10% to 20% from last year, which could be due to factors like increased naloxone availability, according to researchers. The study findings — detailed in a report from NPR — showed a precipitous decline in state-level overdose-related mortality figures, especially among states in the Eastern region.  Several causes behind the drops in fatal and nonfatal overdoses have been hypothesized, but there is no single answer. “In the states that have the most rapid data collection systems, we’re seeing declines of 20%, 30%,” Nabarun Dasgupta, PhD, MPH, a senior scientist at the University of North Carolina Injury Prevention Research Center, told NPR. Healio previously reported that overdose deaths declined from 111,029 in 2022 to 107,543 in 2023, a decrease of 3.1%. During that period, overdose deaths involving opioids dropped from 84,181 to 81,083, whereas deaths linked to synthetic opioids like fentanyl decreased from 76,226 to 74,702. The encouraging trends are expected to continue because the number of drug overdose deaths from April 2023 to April 2024 is predicted to decline by 10% nationwide, according to CDC data. However, Dasgupta and colleagues expressed some skepticism. “It was enough to dig deeper, but we were jaded,” they wrote in a blog post on Opioid Data Lab. “Excitement about dips in overdose indicators end up being transient or explained away by data artifacts.” In the analysis, the researchers assessed state health department dashboards and several overdose metrics, like ED visits, calls to emergency medical services and overdose mortality, to determine if state data aligned with national trends. They found that nonfatal drug overdoses decreased by 15% to 20% from the previous year nationally, whereas fatal overdoses were down by 10%. “There is barely any public health intervention that has credibly achieved this magnitude of decrease,” they wrote. Multiple metrics were consistent with the overall decreases. For example, ED visits were down 15% to 20% through the first 9 months of 2024, whereas first responders reported that nonfatal drug overdoses were down by 16.7% from September 2023 to September 2024.  Dasgupta and colleagues highlighted several hypotheses of what led to the decreases, but “there is no single obvious answer,” they wrote. The researchers pointed out that increased drug treatment, law enforcement operations and marijuana legalization were unlikely to have contributed. They added that that drops in overdoses seemed to align around the time of over-the-counter naloxone becoming available in pharmacies, “but whether those doses were actually used to reverse an overdose, and in what time lag, is debatable.” Depletion of “susceptibles” — the term used to describe building up a tolerance of a drug through past use — was additionally seen as plausible by the researchers, but it is unknown whether there is enough population-level data to tie it to the overdose decreases. Ultimately, “our conclusion is that the dip in overdoses is real, and not a data artifact,” they wrote. “It remains to be seen how long it will be sustained. If it is sustained, whatever caused it would be one of the strongest ‘interventions’ ever witnessed in this domain of public health.” 

For more information: https://tinyurl.com/2jhjehnp

Hep C World News - Week of October 13, 2024

Hot Days and methamphetamine are a deadly mix

Phoenix, AZ - On just 1 sweltering day during the hottest June on record in Phoenix, a 38-year-old man collapsed under a freeway bridge and a 41-year-old woman was found slumped outside a business. Both had used methamphetamine before dying from an increasingly dangerous mix of soaring temperatures and stimulants. Meth is showing up more often as a factor in the deaths of people who died from heat-related causes in the U.S., according to an Associated Press analysis of data from the CDC. Death certificates show about one in five heat-related deaths in recent years involved methamphetamine. In Arizona, Texas, Nevada, and California, officials found the drug in nearly a third of heat deaths in 2023. Meth is more common in heat-related deaths than the deadly opioid fentanyl. As a stimulant, it increases body temperature, impairs the brain's ability to regulate body heat, and makes it harder for the heart to compensate for extreme heat. If hot weather has already raised someone's body temperature, consuming alcohol or opioids can exacerbate the physical effects, "but meth would be the one that you would be most concerned about," said Bob Anderson, PhD, chief of statistical analysis at the National Center for Health Statistics. The trend has emerged as a synthetic drug manufactured south of the border by Mexican drug cartels has largely replaced the domestic version of meth fictionalized in the TV series "Breaking Bad." Typically smoked in a glass pipe, a single dose can cost as little as a few dollars. At the same time, human-caused climate change has made it much easier to die from heat-related causes in places like Phoenix, Las Vegas, and California's southeastern desert. This has been Earth's hottest summer on record. Phoenix baked in triple-digit heat for 113 straight days and hit 117 degrees Fahrenheit (47.2 Celsius) in late September -- uncharacteristic even for a city synonymous with heat. The triple digits have carried into October -- this week, the National Weather Service again warned of excessive heat. "Putting on a jacket can increase body temperature in a cold room. If it's hot outside, we can take off the jacket," explained Rae Matsumoto, PhD, dean of the Daniel K. Inouye College of Pharmacy at the University of Hawaii in Hilo. But people using the stimulant in the outdoor heat "can't take off the meth jacket." These fatalities are particularly prevalent in the Southwest, where meth overdoses overall have risen since the mid-2000s. In Maricopa County, America's hottest major metropolitan area, substances including street drugs, alcohol, and certain prescription medicines for psychiatric conditions and blood pressure control were involved in about two-thirds, or 419 of the 645 heat-related deaths documented last year. Meth was detected in about three-quarters of these drug cases and was often the primary cause of death, public health data show. Fentanyl was found in just under half of them. In Pima County, home to Tucson, Arizona's second most populous city, methamphetamine was a factor in one-quarter of the 84 heat-related deaths reported so far this year, the medical examiner's office said. In metro Las Vegas, heat was a factor in 294 deaths investigated last year by the Clark County coroner's office, and 39% involved illicit and prescription drugs and alcohol. Of those, meth was detected in three-fourths. The U.S. Drug Enforcement Administration notes in its 2024 National Drug Threat Assessment that 31% of all drug-related deaths in the U.S. are now caused by stimulants that speed up the nervous system, primarily meth. More than 17,000 people in the U.S. died from fatal overdoses and poisonings related to stimulants in the first half of 2023, according to preliminary CDC data. Although overdoses have been more associated with opiates like fentanyl, medical professionals say overdosing on meth is possible if a large amount is ingested. Higher blood pressure and a quickened heart rate can then provoke a heart attack or stroke. "All of your normal physiological ways of coping with heat are compromised with the use of methamphetamines," said Aneesh Narang, MD, an emergency medicine physician at Banner University Medical Center in downtown Phoenix. Narang, who sits on a board that reviews overdose fatalities, said the "vast majority" of the heat stroke patients seen in his hospital's emergency department this summer had used street drugs, most commonly methamphetamine. Because of its proximity to the U.S.-Mexico border, Phoenix is considered a "source city" where large amounts of newly smuggled meth are stored and packaged into relatively tiny doses for distribution, said Det. Matt Shay, a seasoned narcotics investigator with the Maricopa County Sheriff's Office. "It's an amazing amount that comes in constantly every day," Shay said. "It's also very cheap." U.S. Customs and Border Protection seized about 164,000 pounds (about 74,000 kilograms) of meth at the U.S.-Mexico border this last fiscal year ending September 30, up from the 140,000 pounds (about 63,500 kilograms) captured in the previous 12 months. And sellers often target homeless people, Shay said. "It's a customer base that is easy to find and exploit," Shay said. "If you're an enterprising young drug dealer, all you need is some type of transportation and you just cruise around and they swarm your car." Jason Elliott, a 51-year-old unemployed machinist, said he's heard of several heat-related deaths involving meth during his 3 years on the streets in Phoenix. "It's pretty typical," said Elliot, noting that stimulants enable people to stay awake and alert to prevent being robbed in shelters or outdoors. "What else can you do? You have stuff; you go to sleep, you wake up and your stuff is gone." Nick Staab, MD, MSPH, assistant medical director of the Maricopa County Department of Public Health, said brochures were printed this summer and distributed in cooling centers to spread the word about the risk of using stimulants and certain prescription medicines in extreme heat. But it's unclear how many are being reached. People who use drugs may not be welcomed at some cooling centers. A better solution, according to Stacey Cope, capacity building and education director for the harm reduction nonprofit Sonoran Prevention Works, is to lower barriers to entry so that people most at risk "are not expected to be absent from drugs, or they're not expected to leave during the hottest part of the day." 

For more information: https://tinyurl.com/3wssx538

Hep C World News - Week of October 6, 2024

CDC warns of potential overdose risk from online pharmacy prescriptions 

Atlanta, GA - The CDC advised that people should take prescriptions only from a licensed HCP and pharmacy. The CDC issued a warning to health care officials, clinicians and patients about a potential risk for overdose among people ordering counterfeit prescription medications from online pharmacies. According to a CDC press release, the U.S. Department of Justice (DOJ) announced charges on Sept. 30 against 18 defendants running illegal online pharmacies. The CDC advised that people should take prescriptions only from a licensed HCP and pharmacy. The agency said that these individuals are advertising, selling, manufacturing and shipping millions of unregulated prescription pills containing fentanyl and methamphetamine to tens of thousands of people in the United States. The DOJ noted in a separate press release that at least nine victims later died of narcotics poisoning, while nine website domains used to sell the counterfeit pills have been seized.  Prescriptions for drugs like GLP-1 receptor agonists from illegal online pharmacies have become increasingly prevalent in the last couple of years. According to a report from IQIVA, the number of prescriptions dispensed annually through illegal online pharmacies increased from 64 million in 2019 to 85 million in 2022, for a compounded yearly growth rate of 10%. IQIVA also found that 12.6% of total adverse events related to illegal dispensing between January 2017 and December 2022 could have been avoided if all drugs purchased from illegal online pharmacies were purchased from legal pharmacies instead. The CDC noted that almost 95% of websites offering prescription-only drugs online operate illegally and that individuals should take medications prescribed only by a licensed health care provider and dispensed by a licensed pharmacy.

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Hep C World News - Week of September 29, 2024

New HCV testing guidelines aim to increase screening among exposed infants

Atlanta, GA - From 2010 to 2020, less than half of perinatally exposed infants were tested for hepatitis C virus, according to a study, but experts are hopeful that new early testing guidelines will ensure more infants are screened and treated. HCV infections quadrupled from 0.3 per 100,000 population in 2009 to 1.2 per 100,000 population in 2018, according to Ezzeldin Saleh, MD, FIDSA, FAAP, and Marcela Rodriguez, MD, pediatric infectious disease specialists from Southern Illinois University School of Medicine. Infection rates were especially high among people aged 20 to 29 years (3.1 per 100,000 population), Saleh and Rodriguez wrote in the Journal of the Pediatric Infectious Diseases Society. The risk for transmission from pregnant women with HIV and HCV to infants was estimated to be around 7.2% to 12.1%, Saleh and Rodriguez wrote. “Infants with perinatal hepatitis C are usually asymptomatic, so the diagnosis relies on identifying all mothers with hepatitis C infection during pregnancy,” Saleh told Healio. In 2020, the CDC recommended HCV screening for every pregnancy and testing exposed infants after age 18 months for HCV antibodies. However, less than half of exposed infants were tested, according to a retrospective study. Rachel L. Epstein, MD, MScE, assistant professor of medicine in the section of infectious diseases at Boston University Chobanian and Avedisian School of Medicine, and colleagues conducted a retrospective national study of HCV testing among exposed infants born from 2010 through 2020. The researchers identified which test children received, if any, and whether the children received antiviral treatment. Median follow-up was 2.9 years (interquartile range, 1.5-4.8 years). Among 8,516 infants exposed to HCV, less than half (45.8%) were tested for the virus, and 42.1% were appropriately tested, according to results published in the Journal of the Pediatric Infectious Diseases Society. Half of the children (51.3%) appropriately tested received antibody testing, 24.6% received RNA testing and 24.1% received both tests.  Of the children appropriately tested for HCV, 182 (5.1%) had positive RNA tests. There were 104 children eligible for treatment by age 3 years, but only 15 were treated.

The researchers uncovered racial and ethnic disparities in testing. Compared with white children, Black and Asian/Pacific Islander children were significantly less likely to receive appropriate testing (OR = 0.38; 95% CI, 0.26-0.55; and OR = 0.06; 95% CI, 0.03-0.11, respectively). Hispanic and Latinx children were less likely to receive appropriate testing than non-Hispanic children (OR = 0.56; 95% CI, 0.36-0.88). “Unfortunately, communication between birthing parent and newborn clinicians and between hospitals and outpatient pediatricians is not always seamless,” Epstein told Healio. “Many diagnoses are likely not communicated clearly to pediatricians seeing the exposed children at 18 months of age, and many general pediatricians do not feel comfortable with HCV testing and diagnosis.” In 2023, the CDC began recommending early testing among infants aged 2 to 6 months.  “The hope is that earlier and simple one-step testing will maximize the chances of testing all exposed children as they are seen for well-child visits around the same time,” Saleh told Healio. “Previous recommendations for testing after 18 months of age had led to a significant number of exposed children being lost to follow-up.” The recommendations state that exposed children should receive an RNA test between age 2 and 6 months, or up to age 17 months if they have not been tested previously, Saleh and Rodriguez wrote. Children aged 18 months or older should receive an antibody test if they have no previous test history. As Healio previously reported, a study found that up to 90% of exposed infants were tested in facilities where the policy was to screen at age 2 months. Children with HCV infection are eligible for antiviral therapy after age 3 years, according to Saleh and Rodriguez. Saleh said antiviral treatment during pregnancy is currently being researched. “General pediatricians are the first line in ensuring all infants exposed to hepatitis C virus are tested,” Epstein said. “Now that universal hepatitis C testing is recommended in pregnancy, pediatricians should ensure that maternal testing is checked and create a workflow to routinely test exposed infants with RNA testing at 2 to 6 months of age and make appropriate referrals for those testing positive.”

For more information: https://tinyurl.com/mrkwfse5

Hep C World News - Week of September 22, 2024

Patients leaving hospital despite advice likelier to OD: study

Vancouver, BC - People who leave the hospital against medical advice are 10 times more likely to suffer an overdose compared to those who leave after being discharged by a doctor, according to a new study in the Canadian Medical Association Journal that examined health data on hospital admissions in British Columbia between 2015 and 2019. A new study has found that patients in B.C. who left hospitals against medical advice were 60 per cent more likely to suffer an overdose within a month of leaving when risk factors were considered. The study, published in the Canadian Medical Association Journal on Monday, was led by researchers at the University of B.C. It examined nearly 190,000 hospital stays in the province between 2015 and 2019. Of those, 6,440 (3.4 per cent) resulted in a "before medically advised" (BMA) discharge. In other words, they left against their doctor's advice. Among that cohort, the study found that when risk factors — like age, sex and being unhoused — were considered, they were 60 per cent likelier to suffer an overdose. Vancouver clinic set to open supervised inhalation rooms More than 15,000 people have died of toxic drugs in B.C. since 2016 "It's often the patients who decide to initiate before medically advised discharge that I'm most worried about," said Dr. John Staples, a clinical associate professor at UBC and a physician at Vancouver General Hospital, who co-wrote the study. "Because I know that their medical problem isn't going to be treated once they leave." Patients who left hospitals despite medical advice were 60% likelier to overdose in the month afterward when risk factors were considered, according to a recent study. (Maggie MacPherson/CBC) Staples said that the study shows the need for the health-care system to perform more interventions to make people feel safe in hospitals and prevent the risk of overdose. "I think that the size of the effect is surprising and impressive," Staples said. "I think it's a real signal that, as a health-care system, we need to be doing a better job of reaching out to these vulnerable patients." Staples pointed to interventions like safe drug consumption sites, as well as better treatment of pain and substance use disorder, as ways that could be helpful for the group of patients who want to leave against their doctor's advice. 

For more information: https://tinyurl.com/bdhu555x

Hep C World News - Week of September 15, 2024

Hospital expands HIV and hepatitis testing

Birmingham, UK - All patients requiring a blood test at Queen Elizabeth Hospital's emergency department will now tested for HIV and hepatitis.  The new protocol at the Birmingham hospital is expected to pick up undiagnosed patients, particularly from the South Asian community.  Earlier trials showed one in 300 patients had tested positive for hepatitis B.  The new service could save lives and cut treatment costs for the NHS. Untreated hepatitis B and C causes liver damage and can lead to liver cancer.  Hepatitis B and HIV can be treated while hepatitis C can be cured. Diana Pell, who was the first patient to be tested, said “I think it’s a good idea. "I just hope that I haven’t got it.” It is thought the rollout could save lives across the city. Dr. Steve Taylor, who has led the rollout for the University Hospitals Birmingham Trust, said many people did not know they were infected by diseases that could lie dormant for years. “People go to places like Pakistan and Bangladesh and need medical treatment," he explained. "They can have injections and can be infected with hepatitis B or C and not know about it.” The emergency ward at the Queen Elizabeth Hospital where testing will be carried out Shabana Begum, who contracted Hepatitis C from an infected needle when she was a teenager, now works with the Hepatitis C Trust in ethnic minority communities and said the treatment for the illness was virtually painless. She said: "What we are trying to do is overcome these stigmas and educate people.” Emergency departments are extremely busy and the new test is designed so staff working there will only have to take one more blood sample.  Specialist nurses will analyse the results and if patients are found to be positive they will be called back for a second test and begin life-saving treatment. More than 1,400 vials of blood will be tested each week and a new automated testing process has had to be set up.  It will later be rolled out across emergency departments in Birmingham and the Black Country. 

For more information: https://tinyurl.com/3uvef68y

Hep C World News - Week of September 8, 2024

Even with HCV cure, surveillance for portal hypertension, HCC ‘should be mandatory’

Punjab, India - Despite achieving cure with direct-acting antivirals, patients with chronic hepatitis C virus-related decompensated cirrhosis remain at risk for progression of portal hypertension, further decompensation and hepatocellular carcinoma. “The introduction of pan-genotypic, highly effective DAAs has transformed the therapeutic paradigm towards HCV elimination,” Madhumita Premkumar, MD, DM, associate professor of hepatology at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, and colleagues wrote in Gastroenterology. “In this study, we assessed the real-world efficacy of a programmatic provision of free-of-charge DAA therapy for management of decompensated chronic HCV-related cirrhosis in a public health care setting in the Punjab state, India.” From July 2018 to July 2023, Premkumar and colleagues enrolled 1,152 patients (mean age, 53.2 years; 63% men) with chronic HCV and decompensated cirrhosis who completed DAA therapy, with follow-ups every 6 months. Studied outcomes included rates of recompensation after achieving sustained virologic response, progression of portal hypertension, further decompensation events and development of hepatocellular carcinoma. Mortality and liver transplantation outcomes were also investigated. At enrollment, 87% of patients had genotype 3 HCV and MELD-Na and Child Pugh Turcotte scores were 16.2 and 12.3, respectively. After a median follow-up of 48.3 months, the researchers reported that 81.8% of patients achieved SVR 12 weeks after the first DAA treatment regimen, with 90.8% achieving SVR after additional treatment courses. The most common decompensation event was ascites (95.3%), which resolved in 86% of patients, followed by variceal bleeding (24.7%) and hepatic encephalopathy (16.6%). Nearly a quarter of patients (24.7%) experienced recompensation, with a median time to occurrence of 16.5 months. Based on multivariable analysis, low bilirubin (adjusted HR = 0.6; 95% CI, 0.5-0.8), international normalized ratio (aHR = 0.2; 95% CI, 0.1-0.3), absence of large esophageal varices (aHR = 0.4; 95% CI, 0.2-0.9) and gastric varices (aHR = 0.5; 95% CI, 0.3-0.7) were associated with recompensation. However, 13.7% of patients exhibited portal hypertension progression, with rebleeding in 4%, linked to previous decompensation with variceal bleeding (aHR= 1.6; 95% CI,1.2-2.8) as well as the presence of large varices (aHR = 2.9; 95% CI,1.3-6.5). The researchers also reported further decompensation in 19% of patients and development of HCC in 2.9%. Further, 12.5% of patients died and six patients required liver transplantation. “Decompensated cirrhosis has cure rates exceeding 81% using all-oral DAAs in a genotype-3 enriched population of decompensated cirrhosis, with nearly a fourth meeting criteria for recompensation and more than a third improving to Child A status over an average period of 4 years,” Premkumar and colleagues wrote. “However, they remain at risk of further decompensation or progression of portal hypertension, with 0.72% having annual risk of HCC after cure.” They continued, “Therefore, surveillance for portal hypertension progression and HCC should be mandatory even after apparent improvement in liver disease severity.” 

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Hep C World News - Week of September 1, 2024

Trends in viral infections in Quebec among people who inject drugs

Montreal, PQ -he Joint United Nations Programme on AIDS (UNAIDS) and the World Health Organization (WHO) consider people who inject drugs a key population to help control the spread of sexually transmitted and blood-borne infections (STBBIs). Important STBBIs in this population include HIV and hepatitis C virus (HCV). These viruses (and other microbes) can be transmitted when equipment (needles, syringes and so on) used by one person to inject drugs is reused by another person.  A team of researchers in Quebec established a network called SurvUDI. This network recruits people who use drugs for periodic surveys. The surveys ask participants about behaviours related to drug use. Participants also undergo screening for HIV and HCV.  The data from periodic surveys helps to keep track of trends in infections among the population of people who use drugs. The data can be used to evaluate and adapt harm reduction programs and the planning and delivery of services to help improve the health of people who use drugs. The information from the surveys complements existing public health measures to monitor trends in STBBIs. According to the Quebec researchers, the participants in their research are generally “hard-to-reach [and] mostly out of treatment (for substance use disorders).” In their latest report, researchers with SurvUDI focused on data collected from nearly 16,000 participants between the years 1995 and 2020. They found that the rate of new HIV infections decreased over time. The rate of new HCV infections, however, initially decreased and then stabilized. They also found changes in behaviours related to drug use. SurvUDI was established in 1995 and most participants were recruited from sites where harm reduction services were provided. Such services included the provision of new syringes/needles and supervised drug consumption. According to the researchers, other places of recruitment included “drop-in centres, detention centres, detoxification clinics, STI clinics and rehabilitation programs.” During surveys, participants provided oral fluid samples. The samples were shipped to Laboratoire de santé publique du Quebec, where they were analysed for antibodies to HIV and HCV. Note that the presence of antibodies to HCV indicates that at some point in the past a person was exposed to this virus; it does not reveal whether the infection has been resolved or is active. To uncover active HCV infection, analysis of blood samples for the genetic material of this virus is necessary. 

For more information: https://tinyurl.com/59fps6mw

Hep C World News - Week of August 25, 2024

HCV elimination efforts in Georgia may advance reaching 2030 goal 

Tbilisi, Georgia - A hepatitis C elimination program in Georgia reduced the estimated annual incidence of new infections by 61% since its launch in April 2015, which may accelerate efforts to reach the global 2030 elimination goal.  “Georgia, a country in the Caucasus region, had a prevalence of chronic HCV infection of 5.4% in 2015, compared with a global average of 1%,” Rania A. Tohme, MD, MPH, the CDC’s associate director for global health in the division of viral hepatitis, and colleagues wrote in the Morbidity and Mortality Weekly Report. “In April 2015, in collaboration with CDC and other partners, Georgia launched the world’s first hepatitis C elimination program.” They continued: “In April 2024, Georgia’s government endorsed a hepatitis B elimination program.” Using published nationwide serologic surveys, Tohme and colleagues complied data on chronic HBV and HCV seroprevalence and used modeled estimates to determine the incidence of new infections. The researchers also used data from the national HCV screening and treatment registries to calculate the number of people who received testing and treatment, as well as vital registry data to estimate combined HBV and HCV mortality. According to serologic survey data from 2021, chronic HCV prevalence was 1.8% (95% CI, 1.3-2.4) — a 67% decrease in disease prevalence from 2015. The survey also found that hepatitis B surface antigen seroprevalence was 0.03% among children and adolescents aged 5 to 17 years and 2.7% in the adult population. “Sustained hepatitis B vaccination coverage above 90% has substantially reduced prevalence of infection in children; however, prevalence in adults remains high,” the researchers wrote, citing consistently high birth-dose and infant vaccination coverage from 2015 to 2023. Modeled analyses from the 2021 survey demonstrated a reduction in the estimated annual incidence of new chronic HCV infection from 132 to 52 per 100,000 in the general population and 2.51 to 1.14 per 100 persons who inject drugs (PWID). However, the combined HBV and HCV mortality increased from 2015 to 2023 (6.3 per 100,000 persons vs. 7.8 per 100,000 persons). Of 2.8 million adults in Georgia, 89.3% underwent HCV antibody screening by April 2024, and of 130,000 people estimated to have current chronic HCV, 82.8% received a positive diagnosis. Among those eligible for treatment, 86.1% initiated and 94.8% completed treatment, with a cure rate of 99%. “Since launching its hepatitis C elimination program in April 2015, Georgia has made substantial progress in diagnosing and treating persons with HCV infection, improving the safety of the blood supply and scaling up prevention services, leading to a 61% decrease in the estimated annual incidence of new chronic HCV infections among the general population and a 55% decline among PWID,” Tohme and colleagues wrote. “Scaling up hepatitis B screening and treating those who are eligible for treatment would decrease hepatitis B-associated morbidity and mortality and expedite progress toward elimination by 2030.” 

For more information: https://tinyurl.com/3upvxncc

Hep C World News - Week of August 18, 2024

Nearly 10% of those prescribed opioids become addicted 

Bristol, UK - Almost one in 10 patients treated with prescription opioid painkillers experience opioid dependency or opioid use disorder, a result from a systematic review and meta-analysis showed. Nearly three in 10 patients in the analysis exhibited signs and symptoms indicating opioid dependency or opioid use disorder (OUD), according to researchers. “Clinicians and policymakers need a more accurate estimate of the prevalence of problematic opioid use in pain patients so that they can gauge the true extent of the problem, change prescribing guidance if necessary, and develop and implement effective interventions to manage the problem,” Kyla H. Thomas, MBBS, MSc, MSc Res, MFPH, PhD, FFPH a professor of public health medicine at the University of Bristol in England, said in a press release. “Knowing the size of the problem is a necessary step to managing it.” The findings conflict with claims from companies like Purdue Pharma, which have said that less than 1% of opioid prescriptions result in problems for patients, the release noted. Prior studies that examined the prevalence of problematic opioid use in patients with chronic noncancer pain had various limitations, Thomas and colleagues wrote in their study, published in Addiction. “A major limitation is the inconsistency in defining problematic opioid use with the use of multiple definitions and terminology (such as misuse, abuse, addiction, dependence, OUD, problematic use and aberrant behavior)” they explained. The researchers aimed to overcome these caveats in a systematic review and meta-analysis of 148 studies — composed of over 4.3 million participants — taken from several databases. The analysis used studies published up until January 2021. The studies came primarily from North America and high-income countries, with study sample sizes ranging from 15 to over 2 million participants. Thomas and colleagues divided the studies into four categories based on how problematic opioid use was defined: opioid dependency and OUD, defined through diagnostic codes; signs and symptoms of opioid dependency and OUD, defined as symptoms like opioid cravings or withdrawal; aberrant behavior, defined as behaviors like seeking early refills and frequently lost prescriptions; and at risk for opioid dependency and OUD, defined as characteristics that could increase the risk for opioid dependency or OUD development. Overall, the pooled prevalence was 9.3% (95% CI, 5.7%-14.8%) for opioid dependency and OUD, 29.6% (95% CI, 22.1%-38.3%) for signs and symptoms of opioid dependency and OUD, 22% (95% CI, 17.4%-27.3%) for aberrant behavior and 12.4% (95% CI, 4.3%-30.7%) for those at risk for dependency and OUD. The researchers identified several study limitations, with the most significant being the “considerable” heterogeneity between the studies across outcomes, which they advised limits the reliability and general applicability of the findings. .They concluded that the results show an urgent need for better approaches to problematic opioid use inpatients  Such strategies could include “the promotion of best practice in opioid prescribing, education of patients and prescribers regarding opioid-related harms [and] improving access to appropriate pain management,” they wrote. 

For more information: https://tinyurl.com/mvwzw6b8

Hep C World News - Week of August 11, 2024

Rising deaths of people without fixed addresses leave families, community workers mourning

Winnipeg, MB - The number of people who died without fixed address rose five-fold over last 5 years in Manitoba according to preliminary data. Nicholas (Sam) Jackson says he and his twin sister went down different paths as they grew into adults, but the one she took ultimately ended her life over a year ago. Sam's sister, Nicole, was homeless when her body was found near train tracks in the southwestern Manitoba city of Brandon, just a week after their 25th birthday in March 2023, he said. She had suffered a drug overdose and was pronounced dead soon after. The two are members of Sioux Valley Dakota Nation who were born in Brandon and spent the majority of their upbringing in foster care, exiting the system when they turned 18 years old in 2016, he said. "We kind of took two ways to heal ourselves," said Sam. "I became a powwow dancer, and she started to express it in a different way." Nicole is among hundreds of people who didn't have a fixed address when they died in Manitoba over the last five years. Preliminary data from the chief medical examiner's office in Manitoba says 350 people without a fixed address died between 2019 to 2023, though it's not the full picture since the office isn't always notified of every such death. Accidents account for the most deaths, killing 150 people, the data says. That number also includes 106 confirmed drug overdoses, representing 30 per cent of all deaths. Another 51 deaths were from natural causes, 31 were deemed homicides and 23 were attributed to suicide. Still, the cause of 95 other deaths are classified as undetermined. However, those numbers are also considered estimates since a medical examiner has not yet finalized the cause behind about 40 per cent of all 350 deaths, and final figures are expected to change. The numbers, which were initially released to CBC in April, would not have changed significantly as of July 16, the office said. The preliminary data shows that the number of people who died without a fixed address rose over five-fold during the five-year period, from 23 people recorded in 2019 to 134 in 2023. Tessa Blaikie Whitecloud, CEO of Siloam Mission, believes that number grew because homelessness increased in Winnipeg after the onset of the COVID-19 pandemic. "Kind of coming out of the pandemic, we start to see significant jumps [in deaths]," Blaikie Whitecloud said, referring to the data. She said she wouldn't be surprised if the number of Manitobans who died without a fixed address in the last five years was actually higher than 350. The numbers are important on a human level, so community members can mourn, but she says it also matters systemically. "If we're not tracking this, then we have no way of knowing if the situation is improving or getting worse." 

For more information: https://tinyurl.com/2n533c43

Hep C World News - Week of August 4, 2024

Prevalence of cirrhosis ‘more than double’ in transgender vs. cisgender adults

Los Angelas, CA - Transgender adults had “more than double” the prevalence of cirrhosis vs. cisgender adults, as well as higher rates of comorbidities linked to liver disease progression, researchers reported in The American Journal of Gastroenterology. “Before this study, there were no liver-specific data focused on transgender individuals,” Brian P. Lee, MD, MAS, study author and associate professor of medicine in the division of gastrointestinal and liver diseases at Keck School of Medicine of USC, told Healio. “To move toward providing equitable care, we need to better understand the landscape of liver disease among transgender individuals, who we hypothesized might be at greater risk for liver disease.” In a retrospective study, Lee and colleagues used Optum’s deidentified Clinformatics Data Mart Database to identify 64,615,316 commercially insured transgender and cisgender adults between 2007 and 2022, of whom 42,471 (0.07%) were transgender. Researchers used billing codes to determine the prevalence of cirrhosis in the cohort, as well as the age-standardized prevalence among both transgender and cisgender groups. They also identified causes of cirrhosis and medical comorbidities and calculated incidence densities of liver-related outcomes and all-cause mortality. According to study results, there were 329,251 individuals with cirrhosis in the entire cohort, of whom 293 (0.09%) were transgender. Compared with cisgender adults, transgender individuals had a higher age-standardized prevalence of cirrhosis (1,285 per 100,000; 95% CI, 1.136-1,449 vs. 561 per 100,000; 95% CI, 559-563), and those with cirrhosis also had higher age-standardized rates of anxiety (70.7%; 95% CI, 56.9-86.9 vs. 43.2%; 95% CI, 42.7-43.8), depression (66.4%; 95% CI, 53.3-81.7 vs. 38.4%; 95% CI, 37.9-38.9) and HIV/AIDS (8.5%; 95% CI, 3.9-16.1 vs. 1.6%; 95% CI, 1.5-1.7). In addition, age-standardized proportions of alcohol (57.5%; 95% CI, 46-71.1 vs. 51%; 95% CI, 50.5-51.6) and viral (30.5%; 95% CI, 22.8-39.8 vs. 24.2%; 95% CI, 23.9-24.5) etiologies for cirrhosis were higher among transgender individuals. However, both groups had similar age-standardized incidence densities of death (transgender, 12; 95% CI, 8.8-15.3 vs. cisgender, 14; 95% CI, 13.9-14.2), liver decompensation (15.7; 95% CI, 10.9-20.5 vs. 14.1; 95% CI, 14-14.3) and liver transplantation (0.3; 95% CI, 0-0.8 vs. 0.3; 95% CI, 0.3-0.4) per 100 person-years. “Transgender vs. cisgender individuals have more than double the prevalence of cirrhosis, especially due to alcohol and/or viral hepatitis,” Lee said. “Yet, once cirrhosis is diagnosed, the rates of poor outcomes like liver decompensation or death were the same among transgender vs. cisgender individuals.” In addition, inverse probability treatment weighting survival analysis, which balanced demographic and clinical characteristics among the two groups, revealed similar 5-year survival probability (63.4%; 95% CI, 56.6-71.1 vs. 59.1%; 95% CI, 58.7-59.4). “Cirrhosis represents end-stage liver disease that has usually occurred over years, and we need to be able to identify and treat risk factors for liver disease earlier to prevent cirrhosis,” Lee told Healio. “Thus, our results suggest that transgender individuals need to be screened and aggressively treated for risk factors of liver disease.” He continued, “Furthermore, the high rates of anxiety and depression that we observed among transgender individuals, which are conditions known to prompt hazardous alcohol use to cope, suggest that more needs to be done to address stigma faced by transgender individuals and [to provide] greater access to mental health resources.” 

For more information: https://tinyurl.com/5n7trfza

Hep C World News - Week of July 28, 2024

Up-to-date HCC screening after HCV cure improves survival in patients with cirrhosis

New Haven, CT - Remaining current on screening for hepatocellular carcinoma correlated with a “survival benefit” in older adults with hepatitis C virus-related cirrhosis who achieved viral cure but later developed HCC, according to researchers. “Multiple observational studies have demonstrated associations of HCC screening, consisting of semiannual imaging and alpha-fetoprotein measurement, with improved detection of early-stage HCC, receipt of curative treatment and overall survival,” Catherine Mezzacappa, MD, of the division of digestive diseases at Yale School of Medicine, and colleagues wrote in JAMA Network Open. “Individuals with HCV-associated cirrhosis who have achieved viral cure may be particularly susceptible to lapses in HCC screening due to treatment-induced stabilization of their liver disease. However, data on clinical HCC screening practices and outcomes in these patients are sparse.” In a retrospective cohort study, researchers included 16,902 patients with HCV-related cirrhosis (median age, 64 years; 97.2% men) in the VA health care system who achieved HCV cure with direct-acting antivirals between 2014 and 2022. Of these, 1,622 patients developed HCC. The primary outcome was overall survival following diagnosis of HCC. According to results, the mean percentage of time participants were up to date with HCC screening after HCV cure decreased from 53.9% to 40.5% from the first to fourth year of follow-up and subsequently increased to 64.2% among those who were still eligible for screening at 8 years. Results also demonstrated a gradual drop in annual cumulative incidence of HCC from 1 year through 8 years (2.4% vs. 1%). In addition, patients with HCC who were up to date with screening at least 50% of the time in the 4 years before their diagnosis had improved overall survival, researchers reported. According to multivariable analysis, each 10% increase in eligible follow-up spent up to date with HCC screening during this time also corresponded with a 3.2% decrease in the hazard of death (HR = 0.97; 95% CI, 0.95-0.99), as well as a hazard reduction of 8% for those diagnosed with HCC between 3 and 4 years after HCV cure and 13% for those diagnosed between 4 and 5 years. Researchers did not observe a correlation for those diagnosed with HCC more than 5 years after HCV cure. Moreover, up-to-date screening correlated with a 10.1% (95% CI, 6.3-14) and 6.8% (95% CI, 2.8-11) increased likelihood of early-stage HCC diagnosis and curative treatment, respectively. “In this cohort study of older adults with cirrhosis and cured HCV, HCC screening was associated with a survival benefit,” Mezzacappa and colleagues wrote. “As the population most impacted by HCV ages, the role of HCC screening after HCV cure requires ongoing evaluation to balance its potential harms and benefits. Our findings suggest that individuals with cirrhosis should be maintained in HCC screening after HCV cure.” 

For more information: https://tinyurl.com/2fx4vy6w

Hep C World News - Week of July 21, 2024

Police say safe supply drugs being diverted then sold 

London, ON - A skyrocketing amount of drugs from safe supply programs in London are being diverted to the streets, police said. “Diverted safe supply is being resold into our community. It’s being trafficked into other communities, and it is being used as currency in exchange for fentanyl, fueling the drug trade,” police chief Thai Truong said. “There’s organized drug trafficking at the highest levels of organized crime. And there’s drug trafficking at the street level. We’re seeing all of it.” Truong spoke at a news conference revealing the results of a six-month crackdown that led to the seizure of weapons, drugs and cash and 247 charges against 50 people. “Criminals will do what they can to earn a profit. They’ll exploit individuals in this community and other communities to earn that profit,” he said. The city’s best-known safe supply program will work with police to review its protocols for preventing diversion, said Scott Courtice, executive director of London Inter Community Health Centre. “I know that we have the leadership and knowledge in our community to find solutions, and we look forward to contributing to those efforts,” he said. But there are at least three other safe supply programs in the city that serve more people than his facility, and he’s not sure what their safeguards are, Courtice said. “We need to stress that we know that diversion is happening from safer supply, but we can’t necessarily know how much of it is coming from the program that we run and how much of those is coming from other prescribers in the community,” he said. “We’re very confident in the protocols. But when our police partners and our public health partners have told us that they’re concerned, we want to work with them.” In safe supply programs, doctors prescribe the opioid hydromorphone, usually in brand name Dilaudid 8mg pills, to people who are at risk from using illicit and potentially deadly street drugs such as the opioid fentanyl. Safe supply and other harm reduction measures – such as supervised drug-use sites, like the one on York Street in London – have become targets of some politicians during the past few years, with federal Conservative Leader Pierre Poilievre promising to shut down those measures. Critics say harm-reduction measures increase the drug supply and overdose rates, and should be replaced by a treatment-only system. Supporters say harm-reduction measures reduce deaths and associated risks of using illicit drugs and give people a chance to survive until they seek treatment. Diversion of hydromorphone has added another layer to the debate, and for police officers, another challenge in the battle against drug trafficking. Just how much diversion was happening in London was made clear at the news conference, where deputy chief Paul Bastien outlined the increases in seizures of Dilaudid 8 pills over the past five years. In 2019, London police seized about 850 tablets of hydromorphone, roughly 10 per cent the Dilaudid 8 pills provided by safe supply, he said. By 2023, that jumped to more than 30,000 tablets of hydromorphone seized, roughly half of it Dilaudid 8 pills, Bastien said. “So far in 2024, we’ve seized just over 12,000 hydromorphone tablets, all but 675 was in Dilaudid 8 mg form,” he said. At the same time, the number of pharmacy robberies targeting opioids dropped from seven in 2019 to one each in the past two years, he said. Investigations from the guns and gangs unit also have shown direct evidence, such as packaging and labelling, of safe supply hydromorphone on the streets, Bastien said. “Taken together all of this has pointed to diversion as an important public safety concern, calling for an enforcement response,” he said. The response during the past six months has resulted in more than $750,000 in drugs seized, including hydromorphone pills, fentanyl, methamphetamine, cocaine, crack cocaine, oxycodone pills and carfentanil, said Det. Sgt. Josh Silcox, head of the guns and gangs section. About $79,877 in cash and 30 firearms also were seized, he said. Asked if London police support safe supply, Truong said police are responsible for enforcement, not making health care policy. “With respect to safe supply and models of health care, I rely on the experts to provide that guidance as well the federal government (and) provincial government,” he said. “We will continue to do enforcement on drug trafficking in this community, which includes the diversion of the safe supply.” Police, the public health unit and InterCommunity Health are partners in the region’s drug and alcohol strategy and will continue to work together, the region’s medical officer of health, Alex Summers, said. 

For more information: https://tinyurl.com/26f7stuu

Hep C World News - Week of July 14, 2024

Opioid-Related Deaths Have Surged in Ontario Shelters

Toronto, ON - The number of accidental opioid-related toxicity deaths more than tripled in shelters across Ontario, Canada, during the COVID-19 pandemic, according to a new study. Between January 2018 and June 2022, 210 accidental opioid overdoses occurred in shelters. Of these events, 48 occurred before the pandemic and 162 occurred during the pandemic. During the study period, the annual number of emergency beds in Ontario grew by only 15%. "Our report highlights the need for improved and expanded harm reduction approaches, overdose response, and staff training and supports within shelters," study author Tara Gomes, PhD, an epidemiologist and principal investigator with the Ontario Drug Policy Research Network and a scientist at St. Michael's Hospital’s Li Ka Shing Knowledge Institute in Toronto, Ontario, Canada, told Medscape Medical News. "Additionally, improved connection to community-base healthcare, treatment programs, and mental health supports is needed for people experiencing homelessness and housing instability," she said. "In combination, we need efforts to address upstream factors such as more accessible housing, income and employment supports, and community-based social supports across the province." The report was published online on June 18 by the Ontario Drug Policy Research Network. The investigators conducted a cross-sectional descriptive study of data from ICES and the Office of the Chief Coroner of Ontario to examine the trends and characteristics of healthcare use among patients who died of an opioid-related toxicity in Ontario shelters between January 2018 and June 2022. They also  analyzed the differences in these variables before and during the COVID-19 pandemic. Forty-eight deaths occurred before mid-March 2020 and 162 after mid-March 2020. The quarterly number of deaths nearly quadrupled from eight deaths in the second quarter of 2018 to 31 deaths in the second quarter of 2022. The rapid increase in deaths began in 2021, when 82 deaths occurred, compared with 38 in 2020. During the prepandemic and pandemic periods, about half of overdose deaths occurred in patients aged 25-44 years. The second highest proportion (about a third) occurred in patients aged 45-64 years. Fewer than 10% of deaths were among patients under the age of 25 years and those aged 65 years or older. More than three quarters of deaths occurred among men. Most opioid-related toxicity deaths in shelters involved non-pharmaceutical opioids 

For more information: https://tinyurl.com/3auek2vc

Hep C World News - Week of July 7, 2024

Larsucosterol reduces mortality by more than 50% in alcohol-associated hepatitis

Hopewell, Virginia - Mitchell L. Shiffman, MD, reports that U.S. patients with severe alcohol-associated hepatitis treated with larsucosterol experienced a “statistically significant” reduction in 90-day mortality — more than 50%. “Severe alcohol use and alcoholic hepatitis significantly increased several years ago during the COVID epidemic,” Shiffman, director of the Liver Institute of Virginia at Bon Secours Mercy Health, said. “Now that COVID is behind us, alcohol use and alcoholic hepatitis continue to remain at very high levels both in the U.S. and many other countries throughout the world. There is no effective treatment for severe alcohol-associated hepatitis.” In the randomized, placebo-controlled, phase 2b AHFIRM trial, Shiffman and colleagues enrolled 307 patients hospitalized with severe alcohol-associated hepatitis at 62 sites, 46 of which were in the U.S., to evaluate the safety and efficacy of larsucosterol. Following a screening period, patients were randomly assigned to a single dose of larsucosterol 30 mg (n = 102) or 90 mg (n = 102) or placebo (n = 103), with administration of a second dose for patients still hospitalized 4 days later. All participants were followed for 90 days and treated according to local standard of care, with steroids given at the discretion of the primary investigator. The primary endpoint was 90-day mortality or liver transplantation. Shiffman noted that a statistical analysis plan prespecified that data from the U.S. study arm would be reported and analyzed separately. According to results presented at EASL Congress, death and LT in the global population was reported among 15.2% and 6.1% in the 30 mg group, respectively, 16.8% and 8.9% in the 90 mg group and 24.5% and 3.9% in the placebo group. Most of the population (78.8%, 74.3% and 71.6%) was alive and transplant-free after 90 days. Overall, larsucosterol 30 mg and 90 mg reduced 90-day mortality by 41% and 35%, respectively, in the global population, although neither were statistically significant. However, in the U.S. population, mortality dropped by 57% and 58% compared with placebo, which did reach significance. Further, patients in the 30 mg and 90 mg arms experienced 24% and 21% fewer treatment-emergent adverse events, which suggests larsucosterol “stabilized and improved liver function, thereby reducing the rate of complications,” Shiffman noted. “In the United States, both larsucosterol groups exhibited statistically significant, more than a 50% reduction, in 90-day mortality,” he said. “The primary endpoint of 90-day mortality or liver transplant did not reach statistical significance in the global study, but it did reach statistical significance in the 30 mg larsucosterol group enrolled in the United States.” Shiffman continued: “Based upon this very exciting data, the U.S. FDA has granted breakthrough therapy designation to larsucosterol for the treatment of alcohol-associated hepatitis.” 

For more information: https://tinyurl.com/4s559sbb

Hep C World News - Week of June 30, 2024

Long-term outcome in compensated advanced chronic liver disease after HCV-cure

London, UK - Around 750.000 patients/year will be cured from hepatitis C-virus (HCV)-infection until 2030. Those with compensated advanced chronic liver disease (cACLD) remain at risk for hepatic decompensation and de-novo hepatocellular carcinoma (HCC). Algorithms have been developed to stratify risk early after cure, however, data on long-term outcome and the prognostic utility of these risk stratification algorithms at later timepoints are lacking. Researchers here retrospectively analysed a cohort of 2335 cACLD-patients (LSM≥10kPa) who achieved HCV-cure by interferon-free therapies from 15 European centres (median age 60.2±11.9 y, 21.1% obesity, 21.2% diabetes). During a median follow-up of 6 years, first hepatic decompensation occurred in 84 patients (3.6%, incidence rate [IR]: 0.74%/year, cumulative incidence at 6 y: 3.2%); 183 (7.8%) patients developed de-novo HCC (IR: 1.60%/year, cumulative incidence at 6 y: 8.3%), with both risks being strictly linear over time. Baveno VII criteria to exclude (FU-LSM <12kPa & FU-PLT >150 G/L) or rule-in (FU-LSM ≥25kPa) clinically significant portal hypertension (CSPH) stratified the risk of hepatic decompensation with proportional hazards. Estimated probability of CSPH discriminated patients developing versus not developing hepatic decompensation in the grey-zone (i.e., patients meeting none of the above criteria). Published HCC risk stratification algorithms identified high- and low-incidence groups, however, the size of the latter group varied substantially (9.9%-69.1%). A granular ‘HCC-SVR’ model was developed to inform on an individual patient’s HCC-risk after HCV-cure. The researchers concluded that in patients with cACLD, the risks of hepatic decompensation and HCC remain constant after HCV-cure, even in the long-term (>3 y). One-time post-treatment risk stratification based on non-invasive criteria provides important prognostic information that is maintained during long-term follow-up, as the hazards remain proportional over time. 

For more information and to read the published abstract: https://tinyurl.com/3mts42ps

Hep C World News - Week of June 23, 2024

DAA treatment ‘longitudinally continues to improve’ liver-related survival in HCV

Treatment of chronic hepatitis C virus with direct-acting antivirals improved liver-related morbidity and survival, regardless of hepatocellular carcinoma, although patients aged older than 60 years should be monitored, a presenter noted. “Treatment of HCV with DAAs results in permanent viral clearance (SVR) in the vast majority of HCV patients,” Eiichi Ogawa, PhD, of Kyushu University Hospital, said at EASL Congress. “Many reports have shown significant reduction in development of HCC and mortality for up to approximately 5 years after SVR. “In conclusion, DAA treatment longitudinally continues to improve liver-related morbidity and survival,” Eiichi Ogawa, PhD, said. Image: Adobe Stock  “In Japan, a huge number of HCV patients were treated with low-cost and unrestricted treatment eligibility, just like the Italian elimination program. However, the age of Japanese patients has progressively increased ahead of other countries.” In a multicenter, retrospective cohort study, Ogawa and colleagues investigated long-term liver-related outcomes and mortality among patients with chronic HCV who achieved SVR by all-oral DAA treatment from 2014 to 2023. Researchers enrolled 3,024 adults (mean age, 64.8 years) without decompensated cirrhosis, of whom 2,689 were HCC-naive and 333 were HCC-experienced. Studied outcomes included the development or recurrence of HCC, survival rate and causes of death. After a median follow-up of 6.5 years, the cumulative rate of de novo HCC incidence longitudinally increased at 3 years (4%), 5 years (5.6%) and 8 years (7%), although rates of recurrence plateaued in nearly 5 years (50.4%, 59.1% and 62%, respectively). Of 377 patients aged younger than 50 years, none developed de novo HCC; however, the annual rate of HCC development was greater than 1.5% for patients aged 75 years and older. Conversely, among 536 patients aged 50 years and older with cirrhosis, incidence rates of new HCC were elevated at 3 years (11.2%), 5 years (15.6%) and 8 years (18.9%). Among patients without cirrhosis, the 8-year cumulative incidence of HCC increased with age (50-59 years, 1.8%; 60 years and older, 5.5%; 75 years and older, 8.7%). Additional factors related to HCC development included male sex (adjusted HR = 2.44; 95% CI, 1.45-4.11) and end-of-treatment alpha-fetoprotein of 7 ng/mL or greater (aHR = 5.59; 95% CI, 3.2-9.77). Survival rates at 3, 5 and 8 years were 85.2%, 74.6% and 67.4%, respectively, in the HCC-experienced group, with 74% of deaths caused by liver-related complications, mainly HCC recurrence. In the HCC-naive group, 8-year survival was more than 90%, with non-liver-related complications causing 72% of deaths, of which 43% were non-liver cancer and 20% were cerebral/cardiovascular disease. “In conclusion, DAA treatment longitudinally continues to improve liver-related morbidity and survival,” Ogawa said. “Noncirrhotic patients aged over 60 — at least over 75 — should be monitored regularly over a long period.” 

For more information: https://tinyurl.com/5n7kpe83

Hep C World News - Week of June 16, 2024

New drug shows promise in easing chronic pain, study finds

Austin, TX - A team of researchers from Virginia Commonwealth University, the University of Texas at Austin and the University of Virginia have made progress toward developing a drug candidate for treating chronic pain more safely. Chronic pain afflicts millions of people, but for many, a reliable, nonaddictive drug to ease their suffering remains out of reach. Some of the most effective drugs for treating severe pain, opioids, are highly addictive and have led to public health crises of substance use disorder and overdoses. In their most recent study, published in Proceedings of the National Academy of Sciences, the researchers found that the drug candidate was able to effectively trick immune systems in such a way as to shut off an inflammatory response, thereby alleviating pain. While this research is currently at the preclinical stage, the ultimate goal is to make an effective and targeted treatment for people suffering from chronic pain. Immune cells in the human body produce compounds called endocannabinoids that, among other things, regulate inflammation. In a healthy person, inflammation is a process that helps the body heal from infections or injuries. But the downside is that it also causes swelling and buildup of tissue that presses on nerve endings and causes persistent pain. "When the endocannabinoids in our bodies cause inflammation, our nerves become sensitized. They react more rapidly with less stimulation than what is normally needed. This causes things that normally wouldn't hurt to suddenly become extremely painful, similar to how we feel when we have a bad sunburn," said Aron Lichtman, Ph.D., a professor in VCU School of Medicine's Department of Pharmacology and Toxicology. In this study, the researchers analyzed an inhibitor called KT109 that blocks the activity of a endocannabinoid-producing enzyme in immune cells called DAGLβ. Ken Hsu, Ph.D., an associate professor in the Department of Chemistry at UT Austin, developed the inhibitor in 2012 as a postdoctoral fellow at The Scripps Research Institute. He has since fostered a long-term collaboration with Lichtman and Hamid Akbarali, Ph.D., also a professor in VCU's Department of Pharmacology and Toxicology, to better understand how inhibiting DAGLβ reduces inflammation and the associated pain. Akbarali's expertise is investigating how inflammation impacts the nervous system at the cellular level. His research team examined how the drug candidate interfered with pain-transmitting neurons in mouse models. "In our lab, we look at the speed and strength of the pain signals that neurons send to the brain, and for this particular project, we analyzed how the drug candidate weakened these signals as they traveled through the nervous system," he said. Lichtman's research team focused on understanding how these cellular processes then impact the behavior and function of mice with chronic pain. "Our process has really been a bottom-up discovery. This research originally started with understanding the inhibitor at the molecular level, while this new study aimed to better understand how the inhibitor has an impact at the cellular and behavioral level," Lichtman said. Previous work demonstrated how KT109 controls inflammation via endocannabinoids and prostaglandins. But in this latest study, the researchers were surprised to discover that it also controls inflammation through an additional pathway, which helps explain why the inhibitor is effective in treating different types of pain. "When you inhibit DAGLβ, your immune cells are tricked into thinking they are starving," Hsu said. "Changes in energy metabolism in the immune system can turn off inflammatory signaling and be effective in pain management. One example is the drug metformin," which is commonly used to treat diabetes but also has been found effective in treating pain. The team's inhibitor targets the enzyme DAGLβ, which is mainly present and active in immune cells, thereby avoiding any unnecessary reaction with other cells that might lead to side effects. "You're going to affect these pathways where it matters, where the inflammation is happening," Hsu said. The researchers don't believe this drug inhibitor acts in the brain, thereby avoiding the potential alteration of reward pathways in the brain that might lead to substance abuse. The research team has so far only studied the effects of the inhibitor through injection, but the goal is to develop a pill that can be swallowed, as a human would ingest a drug compound. To avoid internal toxicity, the researchers will aim to refine the chemistry and reduce the number of times the medicine needs to be taken while maintaining the same pain-easing effect. The findings are helpful for pharmaceutical companies considering the development of medicines that target DAGLβ in people experiencing chronic pain. 

For more information: https://tinyurl.com/ykpccbxt

Hep C World News - Week of June 9, 2024

The battle for MDMA as drug steps closer to becoming a prescription medicine

Silver Spring, Maryland - MDMA could be reclassified as a prescription medicine and made available to specially certified doctors and therapists. Currently MDMA is in the same ultra-restrictive category as heroin The Food and Drug Administration posted its initial review of the drug MDMA on Friday, ahead of a meeting of outside advisers who could help decide whether it becomes the first of its kind to win US approval as a medication.  It comes as health regulators question the safety and evidence behind the first bid to use MDMA, the mind-altering club drug, as a treatment for PTSD. It is part of a decadeslong effort by advocates to move psychedelic drugs into the medical mainstream. The experts will discuss the quality of the evidence and safety concerns, including MDMA's potential for abuse, before taking a nonbinding vote on the drug's overall benefits and risks. The FDA will make the final decision, likely in August. In their assessment, FDA scientists said that patients who received MDMA and talk therapy showed “rapid, clinically meaningful, durable improvements in their PTSD symptoms,." But they also called the research “challenging to interpret,” and questioned how long the benefits might last. They said it’s difficult to know how much of the improvement came from MDMA versus simply undergoing intensive therapy, and also raised several safety concerns, including MDMA's potential to cause heart problems. Post-traumatic stress disorder is closely linked to depression, anxiety and suicidal thinking and is more prevalent among women and veterans. Currently antidepressants are the only FDA-approved drugs for the condition. If approved, MDMA would be reclassified as a prescription medicine and made available to specially certified doctors and therapists. Currently the drug is in the same ultra-restrictive category as heroin and other substances the federal government deems prone to abuse and devoid of any medical use. MDMA, also known as ecstasy or molly, is the first in a series of psychedelics that are expected to be reviewed by the FDA in coming years. It’s part of a resurgence of research into the potential of psychedelics for hard-to-treat conditions like depression, addiction and anxiety. MDMA's main effect is triggering feelings of intimacy, connection and euphoria. Companies are studying MDMA, psilocybin, LSD and other mind-expanding drugs for numerous mental health problems.  Until recently, psychedelic research was mainly funded by a handful of nonprofit advocacy groups, including Multidisciplinary Association for Psychedelic Studies, or MAPS. The company seeking approval for MDMA, Lykos Therapeutics, is essentially a corporate spinoff of MAPS, which conducted all the studies submitted for FDA review.  While MDMA would be a first-of-a-kind approval, U.S. doctors and the FDA itself have already laid some of the groundwork for working with drugs that can cause intense, psychological experiences. 

For more information: https://tinyurl.com/k4cptw7w

Hep C World News - Week of June 2, 2024

State-Specific Hepatitis C Virus Clearance Cascades 

Atlanta, GA - Hepatitis C is a deadly, yet curable, disease. National goals for 2030 call for at least 80% of persons with hepatitis C to achieve viral clearance through well-tolerated, highly effective treatment. Analysis of 2013–2022 data from a large national, commercial laboratory found that hepatitis C viral clearance proportions among persons with hepatitis C varied by state from 10% to 51% and fell below established hepatitis C viral clearance goals in all jurisdictions. The assessment of variations in hepatitis C testing and treatment can help identify gaps, prioritize activities to improve linkage to treatment and prevention services, and allocate resources for state hepatitis C elimination programs. Hepatitis C is a deadly, yet curable, disease. National hepatitis C elimination goals for 2030 call for at least 80% of persons with hepatitis C to achieve viral clearance. A well-tolerated treatment results in sustained viral clearance in ≥95% of cases. Hepatitis C virus (HCV) clearance cascades characterize a sequence of steps that follow the progression from testing to sustained viral clearance. Monitoring HCV clearance cascades is important for tracking progress toward elimination goals and identifying gaps in diagnosis, treatment, and prevention. State-specific HCV clearance cascades based on laboratory results were developed using longitudinal data from a large national, commercial laboratory during January 1, 2013–December 31, 2022. State-level estimates of viral testing among persons with evidence of past or current HCV infection ranged from 51% (Hawaii) to 99% (South Dakota), and hepatitis C viral clearance among persons with diagnosed HCV infection ranged from 10% (West Virginia) to 51% (Connecticut). These are the first state-level estimates using CDC guidance and data from a large commercial laboratory with national coverage to generate HCV clearance cascades. These estimates reveal substantial gaps in hepatitis C diagnosis, treatment, and prevention and can help guide prioritization of activities and resources to achieve hepatitis C elimination goals. During January 2017–March 2020, approximately 2 million adults in the United States were estimated to be infected with hepatitis C virus (HCV) (1), and new infections approximately doubled from 2013–2022, primarily in association with injection drug use (2). Untreated, HCV infection can lead to advanced liver disease, liver cancer, and death; hepatitis C screening is recommended for all adults (3). An 8–12-week course of well-tolerated, oral treatment with direct-acting antiviral (DAA) agents is recommended for nearly all persons with HCV infection (4); treatment results in sustained viral clearance in ≥95% of cases (5), making elimination of hepatitis C as a public health threat feasible. The U.S. Department of Health and Human Services (HHS) 2021–2025 Viral Hepatitis National Strategic Plan (6) provides a framework for hepatitis C elimination in the United States and calls for increasing the percentage of persons who have cleared HCV infection to at least 58% by 2025 and 80% by 2030. Substantial variation exists among states with respect to hepatitis C disease incidence and public policies affecting access to hepatitis C treatment and prevention services for persons with or at risk for acquiring hepatitis C. The HCV clearance cascade process quantifies the proportions of persons with HCV at the following five steps: 1) those who were ever infected with HCV, 2) those who received complete (e.g., HCV RNA) testing, 3) those who were identified as having an initial infection, 4) those who subsequently demonstrated viral clearance either spontaneously or in response to treatment, and 5) among those who initially cleared the virus, subsequently had evidence of recurrent viremia because of either persistent infection (e.g., unsustained viral clearance because of treatment failure) or reinfection because of ongoing risk for acquiring hepatitis C. Each state should characterize its own HCV clearance cascade to monitor progress toward state-specific hepatitis C elimination goals and prioritize allocation of public health resources. In 2021, CDC published guidance for developing a simplified HCV clearance cascade based on HCV laboratory test results, such as those contained in public health surveillance systems (7). However, many state public health surveillance systems do not include comprehensive HCV test results or lack the ability to receive, deduplicate, and track person-level longitudinal laboratory test results, precluding the development of state-level HCV clearance cascades. Longitudinal commercial laboratory results have been used to develop a national HCV clearance cascade (8). The primary goal of this study was to develop state-specific HCV clearance cascade estimates to assist states in identifying opportunities to diagnose, treat, and prevent HCV infections in their jurisdiction. 

For more information: https://tinyurl.com/2w7y7mu9

Hep C World News - Week of May 26, 2024

Study looks at syringe reuse among people who inject drugs 

Atlanta, GA - Personal syringe reuse (i.e., reuse of one's own syringes) can place people who inject drugs at increased risk for infectious disease but has received relatively little attention in published literature. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs in rural Kentucky. Participants (n = 238) completed interviewer-administered questionnaires on syringe reuse and demographic, behavioral, and service access characteristics. The unadjusted negative binomial regression with cluster-robust standard errors was used to model the associations with a logged offset for number of injections in the past 30 days. The average age of the sample was 35 and 59.7 % were male. Most participants (77.7 %) reused syringes at least once in the past 30 days, using each syringe a median of three times. Reuse was higher among those who were older and reported a higher street price for syringes. Syringe reuse was lower among people who were within walking distance to a syringe service program (SSP) and who obtained most of their syringes from SSPs or pharmacies. The researchers concluded that syringe reuse among people who inject drugs in rural Kentucky is common. However, these data suggest that increased access to syringes from SSPs and pharmacies, as well as policy-level interventions that reduce street syringe price, might reduce syringe reuse and related harms. 

For more information: https://tinyurl.com/y66w87vd

Hep C World News - Week of May 19, 2024

Telemedicine results in higher HCV cure rates vs. referral in opioid treatment programs

Buffalo, NY - Facilitated telemedicine integrated into opioid treatment programs for patients with hepatitis C virus infection resulted in “substantially higher” cure rates compared with offsite referral to a hepatitis specialist, according to a study. Additionally, illicit drug use declined among all cured patients. “People with opioid use disorder are an underserved population largely because of societal stigma,” Andrew H. Talal, MD, MPH, professor of medicine and director of the Center for Research and Clinical Care in Liver Disease at the University of Buffalo, and colleagues wrote in JAMA. “Opioid treatment programs (OTPs) are convenient, comfortable and non-stigmatizing health care delivery sites that successfully integrate medical and behavioral treatment for opioid use disorder. “In a single-group, single-site study, HCV care through OTP-integrated facilitated telemedicine encounters integrated into OTPs resulted in high cure rates with high patient satisfaction.” In a prospective, cluster randomized clinical trial, Talal and colleagues compared sustained virologic response rates among 602 patients (61.3% men; 50.8% white) with HCV and opioid use disorder at 12 OTPs throughout New York between March 2017 and February 2020. Researchers enrolled 290 patients (mean age, 47.1 years) into a group that received facilitated telemedicine for HCV treatment and 312 patients (mean age, 48.9 years) into a group that received standard-of-care referral to a hepatitis specialist. All programs began with offsite referral to a hepatitis specialist, and every 9 months four sites transitioned to facilitated telemedicine during three separate steps without patient crossover. The primary outcome was HCV cure. Secondary outcomes included treatment initiation and completion rates with direct-acting antivirals, patient satisfaction with delivery of care and treatment adherence rates. The incidence of HCV reinfection was an exploratory outcome. According to results, 96.6% of patients in the telemedicine group completed their initial visit, as did 95.2% in the referral group. Conversely, 92.4% and 40.4%, respectively, initiated treatment with DAAs. Intention-to-treat cure rates were 90.3% vs. 39.4%, with an estimated logarithmic odds ratio of time-averaged intervention effect of 2.9 (95% CI, 2-3.5), based on combined results of 20 datasets. In addition, patients in the telemedicine group experienced significantly shorter time between screening and initial appointments compared with those in the referral group (median, 14 vs. 18 days), as well as less time between initial appointments and treatment initiation (mean, 49.9 vs. 123.5 days). Illicit drug use decreased significantly in both telemedicine (95% CI, 0.3-1) and referral (95% CI, 1.2-4.8) groups, and researchers reported minimal reinfections (n = 13), with an overall incidence of 2.5 per 100 person-years. Individuals in both groups rated satisfaction with health care delivery as “high or very high.” “OTP-integrated facilitated telemedicine resulted in substantially higher sustained virologic response rates than offsite referral,” Talal and colleagues wrote. “Our intervention successfully builds patient-clinician trust across the screen and significant decreases in substance use were observed in cured participants with minimal HCV reinfections.” They continued: “Opioid treatment program-integrated facilitated telemedicine promotes increased access and integrates HCV treatment into venues that offer opioid use disorder treatment.” 

For more information: https://tinyurl.com/4huetac3

Hep C World News - Week of May 12, 2024

Study finds big jump in addiction treatment at community health clinics

Portland, OR - The number of health care professionals able to write a prescription for a key medication to treat addiction quadrupled at community health clinics from 2016 to 2021, according to a new study by researchers at Oregon Health & Science University. The findings, published online today in the journal JAMA Health Forum, provides a glimmer of hope amid a national overdose epidemic that has claimed more than 100,000 lives in the United States in each of the past few years. The study examined community health centers serving low-income people primarily in West Coast states. Researchers found the number of health care professionals prescribing buprenorphine increased from 8.9% to 37.5% from 2016 to 2021—a substantial increase that researchers attribute to increased state and federal efforts to ease the ability of clinicians to prescribe medication to treat addiction. Buprenorphine, approved by the Food and Drug Administration in 2002, relieves withdrawal symptoms, cravings and pain. It normalizes brain function by acting on the same target in the brain as opioids or heroin. It's one of three medicines approved by the FDA for treatment of opioid dependence, along with methadone and naltrexone. "It's heartening," said lead author Daniel Hartung, Pharm.D., M.P.H., associate professor in the OHSU-Oregon State University College of Pharmacy. "Over a third of the providers in these community health centers are writing prescriptions for buprenorphine." Researchers examined data from 166 clinics in the network supported by Portland-based OCHIN, Inc. The study included more than 1,300 health care professionals that provided care for some 570,000 people in 2021. In clinics in rural areas, the proportion of health care professionals able to prescribe buprenorphine was even greater, growing from 20.3% to 52.7% in five years. "There's still a lot of work to be done," Hartung said. "But it's a step in the right direction when more providers have the capacity to write prescriptions to treat patients who want to be treated." In addition to Hartung, co-authors included Robert W. Voss, M.S., of OCHIN, Inc.; Steffani R. Bailey, Ph.D., and Nathalie Huguet, Ph.D., associate professors of family medicine in the OHSU School of Medicine; and John Muench, M.D., M.P.H., professor emeritus of family medicine in the OHSU School of Medicine. 

For more information: https://tinyurl.com/yey9arkn

Hep C World News - Week of May 5, 2024

The harm-reduction movement has lost sight of what truly matters

Vancouver, BC - Earlier this year the federal government delayed an extension of medical assistance in dying (MAID) to include those suffering solely from mental illness, which could have included people with substance use disorder. At the same time, British Columbia’s provincial officer of health called for the province’s “safe supply” program to be expanded. Both policies should be rejected outright, according to an opinion piece recently published in the National Post. Recovery from addiction is real, it works and it’s the only humane policy for people with a substance use disorder. Canada has fully embraced extreme harm reduction, a primarily activist-driven approach to drug policy that aims to promote “safe” or “regulated” drug use, rather than discouraging it and encouraging people to seek treatment. The harm-reduction only strategy includes policies that fully decriminalize drugs like fentanyl and meth and provides potentially deadly prescription drugs to users. Now, as the drug crisis has further spiraled out of control, some people want to double down on these policies, including decriminalization, expanding safe supply and allowing MAID for drug users. Harm-reduction advocates made inroads by arguing that individuals should be kept alive so that they can ultimately enter treatment and be given a second chance at life. Now, the movement has been hyper-extended to a grim point, where some seem to have given up on the prospect of a better tomorrow. Harm reduction is not inherently bad. For those on the far end of the use spectrum — the hard to reach, hard to engage with population — it can be a way to bring them into services and get them into recovery. Meeting people where they are at can be valuable to get them the help they need. But it is only one of many tools, reserved for those who really need it. Millions of people in recovery in North America are testament to the fact that treatment works, even if people take different paths to get there. Harm reduction should be just one part of a broader strategy to prevent drug use before it starts, treat substance use disorder, shut down open-air drug markets and increase international co-operation to reduce drug flows. The harm-reduction movement has drifted from its founding values and disregarded the lives of drug users. It is extremely discouraging to hear Dr. Bonnie Henry, B.C.’s provincial health officer, state that, “Abstinence … just doesn’t work for people who have a dependency on opioids.” This statement is unprecedented, wrong, and without scientific merit. Policymakers should learn from and celebrate the millions of individuals who have overcome their substance use disorders and achieved recovery. These individuals illustrate that recovery is possible and provide hope to those who are currently struggling with addiction. To get people into recovery, of course, we need more and better treatment options. That places like Vancouver’s Downtown Eastside have little quality treatment available — but plenty of cheap drugs — shows how far we have to go. Treatment varies from traditional 12-step programs to medication-assisted treatment, such as methadone and buprenorphine for opioid use disorder. 

For more information: https://tinyurl.com/2k99zmxf

Hep C World News - Week of April 28, 2024

Urgent action needed to achieve viral hepatitis elimination

Lisbon, Portugal - The headline figures from WHO's 2024 Global Hepatitis Report, released at the World Hepatitis Summit in Lisbon, Portugal, on April 9, make for stark reading. 1·3 million people died from viral hepatitis in 2022: the same number as killed by tuberculosis, second only to COVID-19 as the leading communicable cause of death, and an increase on the 2019 estimate of 1·1 million. There were 1·2 million new hepatitis B infections and almost 1 million new hepatitis C infections in 2022—marginally lower than 2019 estimates, but not substantially so. The report, which gathers data from 187 countries, estimates that around 254 million people were living with hepatitis B and 50 million were living with hepatitis C in 2022. In terms of diagnosis and treatment, only 13% of people living with chronic hepatitis B had been diagnosed and around 3% had received antiviral therapy at the end of 2022. And, between 2015 and 2022, only 36% of individuals living with hepatitis C had been diagnosed and 20% had received curative treatment by the end of 2022. These represent small improvements against 2019 data but fall well short of the goal to treat 80% of those living with hepatitis B and C by 2030. Although many countries have now developed national plans to tackle viral hepatitis, implementation has been variable, with limited decentralization being a key constraint on scaling up testing and treatment. Access to rapid diagnostic testing at the primary care or community levels is limited, as is the availability of affordable, simplified treatment regimens. Considerable emphasis must be placed on the simplification and decentralization of care, with integration of viral hepatitis into existing services. The report rightly calls for a shift to a public health approach to tackling viral hepatitis, the success of which has been amply demonstrated by Egypt's strides towards elimination of hepatitis C. Access to the tools needed to eliminate viral hepatitis—diagnostics, treatment, and, in the case of hepatitis B, preventive vaccination—remains a major hurdle. For instance, 63% of new hepatitis B infections occur in the WHO African Region, where only 18% of newborn children receive hepatitis B birth-dose vaccination. The resumption of Gavi, the Vaccine Alliance's support for the roll-out of hepatitis B birth-dose vaccination from June, 2024, will thus be crucial. Major disparities exist in the price paid for treatment, despite the availability of generic versions or their inclusion in voluntary licensing agreements—the report notes, for instance, that, although tenofovir disoproxil fumarate is off-patent and has a global benchmark price of US$2·4 a month, only seven of 26 countries surveyed paid this price or less for the drug. Similarly, only four of 24 countries reported paying the benchmark price of $60 or less for a 12-week course of sofosbuvir–daclatasvir. Efforts must be directed at ensuring the affordability of treatment through pricing policies and procurement strategies. Such efforts are all the more important given that funding for the viral hepatitis response remains limited, despite ample evidence that the elimination of viral hepatitis would be rapidly cost-saving. 

For more information: https://tinyurl.com/2k99zmxf

Hep C World News - Week of April 21, 2024

Rates and causes of death after release from incarceration

Sydney, Australia - Formerly incarcerated people have exceptionally poor health profiles and are at increased risk of preventable mortality when compared with their general population peers. However, not enough is known about the epidemiology of mortality in this population—specifically the rates, causes, and timing of death in specific subgroups and regions—to inform the development of targeted, evidence-based responses. Researchers in Australia aimed to document the incidence, timing, causes, and risk factors for mortality after release from incarceration. They analysed linked administrative data from the multi-national Mortality After Release from Incarceration Consortium (MARIC) study. We examined mortality outcomes for 1 471 526 people released from incarceration in eight countries (Australia, Brazil, Canada, New Zealand, Norway, Scotland, Sweden, and the USA) from 1980 to 2018, across 10 534 441 person-years of follow-up (range 0–24 years per person). We combined data from 18 cohort studies using two-step individual participant data meta-analyses to estimate pooled all-cause and cause-specific crude mortality rates (CMRs) per 100 000 person-years, for specific time periods (first, daily from days 1–14; second, weekly from weeks 3–12; third, weeks 13–52 combined; fourth, weeks 53 and over combined; and fifth, total follow-up) after release, overall and stratified by age, sex, and region. They found that  75 427 deaths were recorded. The all-cause CMR during the first week following release (1612 [95% CI 1048–2287]) was higher than during all other time periods (incidence rate ratio [IRR] compared with week 2: 1·5 [95% CI 1·2–1·8], I2=26·0%, weeks 3–4: 2·0 [1·5–2·6], I2=53·0%, and weeks 9–12: 2·2 [1·6–3·0], I2=70·5%). The highest cause-specific mortality rates during the first week were due to alcohol and other drug poisoning (CMR 657 [95% CI 332–1076]), suicide (135 [36–277]), and cardiovascular disease (71 [16–153]). We observed considerable variation in cause-specific CMRs over time since release and across regions. Pooled all-cause CMRs were similar between males (731 [95% CI 630–839]) and females (660 [560–767]) and were higher in older age groups. The markedly elevated rate of death in the first week post-release underscores an urgent need for investment in evidence-based, coordinated transitional healthcare, including treatment for mental illness and substance use disorders to prevent post-release deaths due to suicide and overdose. Temporal variations in rates and causes of death highlight the need for routine monitoring of post-release mortality. The study was funded by Australia's National Health and Medical Research Council. 

For more information: https://tinyurl.com/5a3ktzsy

Hep C World News - Week of April 14, 2024

Start of a New Trend? Hepatitis C Cases Drop in the U.S.

Atlanta, GA -  New U.S. hepatitis C infections dropped slightly in 2022, a surprising improvement after more than a decade of steady increases, federal health officials said Wednesday. Experts are not sure whether the 6% decline is a statistical blip or the start of a downward trend. Seeing 2023 and 2024 data, when it's available, will help public health officials understand what's going on, said Daniel Raymond, director of policy at the National Viral Hepatitis Roundtable, an advocacy organization. "We've had a decade of bad news ... I am cautiously encouraged," he said. "You always want to hope something like this is real, and a potential sign that the tide has turned." Drops in infection rates did not occur across the board. They declined for white Americans, but continued to rise in Black, Latino, and Native American communities, according to Neil Gupta, MD, MPH, who oversees the branch of the CDC that tracks viral hepatitis. The hepatitis C virus is spread through contact with blood from an infected person. The virus does most of its damage by infecting the liver, and, if left untreated, can lead to cirrhosis or liver cancer. Infections are driven mainly by people injecting illicit drugs. Data released by the CDC for 2022opens in a new tab or window show 4,848 new infections, down from 5,023 reported the year before. actually, estimates about 67,000 new hepatitis C infections actually occurred in 2022, because many people who become infected don't realize it, meaning most new infections are not diagnosed and reported. But that too is down, from 70,000 estimated for 2021. The new infection rate -- used to better compare data from one year to another -- dropped 6%. Though the decline is encouraging, Gupta said, the 2022 statistics are still twice as high as what the nation saw in 2015. Cases had consistently gone up since 2013 during the longstanding opioid epidemic due to drug users shooting heroin and fentanyl. Experts say a couple of factors could have contributed to a decline in 2022, including successful prevention efforts and needle exchanges. The North American Syringe Exchange Network (NASEN) keeps a directory of U.S. programs, and listings have grown from about 300 to nearly 500 in the last several years, said Paul LaKosky, PhD, NASEN's executive director. Many programs also have boosted hepatitis C testing and found ways to get infected people to treatment, he noted. But LaKosky and others think something else may be at play, too: Drug users are shifting from injecting to smoking. A recent CDC report found that between early 2020 and late 2022, the percentage of overdose deaths with evidence of smoking rose 74%, while the percentage of deaths with evidence of injection fell 29%. Fewer people injecting drugs like fentanyl means fewer opportunities for the spread of hepatitis C, experts noted. "There has been a tremendous shift in the way people are consuming their drugs. There's been a decrease in demand for syringes. We've seen this nationwide," said LaKosky, who added there is more demand for supplies to snort or smoke drugs. More than 2 million Americans are infected with hepatitis C, some of them having lived with infections for many years, the CDC estimates. About 12,700 Americans died in 2022 of hepatitis C-related causes, according to the CDC. 

For more information: https://tinyurl.com/297syuy7

Hep C World News - Week of April 7, 2024

WHO sounds alarm on viral hepatitis infections claiming 3500 lives each day

Geneva, Switzerland - According to the World Health Organization (WHO) 2024 Global Hepatitis Report, the number of lives lost due to viral hepatitis is increasing. The disease is the second leading infectious cause of death globally -- with 1.3 million deaths per year, the same as tuberculosis, a top infectious killer. The report, released at the World Hepatitis Summit, highlights that despite better tools for diagnosis and treatment, and decreasing product prices, testing and treatment coverage rates have stalled. But, reaching the WHO elimination goal by 2030 should still be achievable, if swift actions are taken now. New data from 187 countries show that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Of these, 83% were caused by hepatitis B, and 17% by hepatitis C. Every day, there are 3500 people dying globally due to hepatitis B and C infections. “This report paints a troubling picture: despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “WHO is committed to supporting countries to use all the tools at their disposal - at access prices - to save lives and turn this trend around.” Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. New incidence estimates indicate a slight decrease compared to 2019, but the overall incidence of viral hepatitis remains high. In 2022, there were 2.2 million new infections, down from 2.5 million in 2019.  These include 1.2 million new hepatitis B infections and nearly 1 million new hepatitis C infections. More than 6000 people are getting newly infected with viral hepatitis each day. The revised estimates are derived from enhanced data from national prevalence surveys. They also indicate that prevention measures such as immunization and safe injections, along with the expansion of hepatitis C treatment, have contributed to reducing the incidence.  Across all regions, only 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (7 million) had received antiviral therapy at the end of 2022. Regarding hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. These results fall well below the global targets to treat 80% of people living with chronic hepatitis B and hepatitis C by 2030. However, they do indicate slight but consistent improvement in diagnosis and treatment coverage since the last reported estimates in 2019. Specifically, hepatitis B diagnosis increased from 10% to 13% and treatment from 2% to 3%, and hepatitis C diagnosis from 21% to 36% and treatment from 13% to 20%. The burden of viral hepatitis varies regionally. The WHO African Region bears 63% of new hepatitis B infections, yet despite this burden, only 18% of newborns in the region receive the hepatitis B birth-dose vaccination. In the Western Pacific Region, which accounts for 47% of hepatitis B deaths, treatment coverage stands at 23% among people diagnosed, which is far too low to reduce mortality.  Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam, collectively shoulder nearly two-thirds of the global burden of hepatitis B and C. Achieving universal access to prevention, diagnosis, and treatment in these ten countries by 2025, alongside intensified efforts in the African Region, is essential to get the global response back on track to meet the Sustainable Development Goals. 

For more information: https://tinyurl.com/pwhep7yj

Advocate doctors criticize safer supply programs

Vancouver, BC - A group of 72 doctors in B.C., including several of the province’s leading physicians, have signed a letter criticizing Canada’s experimental “safer supply” programs. The letter argues that, not only are these programs unscientific, but they are also being widely defrauded and seriously harming youth. “Safer supply” refers to the distribution of free recreational drugs, typically through prescription, as an alternative to potentially tainted street substances. While advocates claim that these programs save lives, there is widespread evidence that clients regularly resell (“divert”) their safer supply on the black market to purchase stronger illicit drugs, which then floods communities with cheap opioids and fuels new addictions, particularly among youth. Dozens of addiction experts have also argued that there is no evidence that safer supply works. Most studies which support the strategy use low-quality research methodologies that are considered unacceptable in most healthcare studies – for example: simply asking drug users if they benefit from safer supply, or if they resell their drugs, and then treating their answers as objective fact. The new 72-doctor letter, which was originally published in February as an op-ed in the Times Colonist, reiterated many of these concerns and expressed frustration with the B.C. NDP’s inconsistent claims about safer supply. Lead author Dr. Mark Mallet, a hospitalist at Victoria General Hospital, wrote that, although the provincial government spent nearly a year dismissing safer supply diversion as an “urban myth,” it was gratifying to see top officials recently admit that it is actually a common occurrence. However, he said that it is “unsettling” that such officials, including Provincial Health Officer Bonnie Henry, repeatedly assured the public that diversion was being closely monitored when, evidently, it was not. Dr. Mallet also expressed frustration with the government’s tendency to vilify doctors who criticize safer supply. Until very recently, such experts often stood accused of “politicizing” the issue and inciting a “moral panic” through “anecdotes” – but their concerns, by the provincial government’s own admission, turned out to be entirely justified. The doctor said that it is shocking that, almost four years after safer supply was expanded across Canada, there are still almost no credible studies into these programs or their unintended consequences. “We should be drowning in evidence by now,” he wrote, noting that, in light of this gap, it is “not surprising” that harm reduction advocates have been able to dismiss signs of diversion as merely anecdotal. “It is impossible for anecdotes to rise to the level of evidence if no one is systematically collecting data.”

For more information: https://tinyurl.com/ew479du8

Hep C World News - Week of March 31, 2024

Researchers encourage simultaneous testing for three viruses – HIV, HBV and HCV

Toronto, ON - Due to shared routes of infection, some populations are vulnerable to coinfection with HIV and/or hepatitis B virus and/or hepatitis C virus. Testing for all three viruses is not always done. This can allow some infections to go undiagnosed, cause harm and spread. Coinfection with these blood-borne viruses can accelerate the course of illness caused by each one. HBV and HCV are collectively referred to as viral hepatitis. These viruses infect the liver and gradually injure this vital organ, leading to persistent fatigue, the formation of scarred liver tissue, serious infections, liver failure and increased risk of liver cancer and death. Treatment for HBV is available to help manage the infection and allow people to live long, healthy lives. Treatment for HCV can cure this viral infection. Treatment for HIV (antiretroviral therapy, ART) can make a person healthier and, in many cases, allow for near-normal life expectancy. Furthermore, a person with HIV who is on effective treatment cannot pass on the virus to their sexual partners. However, if left untreated, HIV can severely damage the immune system. Testing for all three viruses could help uncover previously undiagnosed infections and allow healthcare personnel to offer treatment.  Worldwide, it is estimated that collectively there are more than four million infections of HBV, HCV and HIV each year. What’s more, annual deaths from all three viruses are estimated to be 1.7 million. A team of researchers in the UK notes that without systemic intervention HBV and HCV will cause “more deaths [globally] annually than HIV, malaria and tuberculosis combined” by 2040. Although much progress has been made against HIV, with many people being tested and offered treatment when a positive test occurs, in contrast, progress against viral hepatitis (hepatitis B and C viruses) is lagging.  A major barrier to progress against infection with all three viruses is access to testing. To begin to remedy this, in 2022 the World Health Organization (WHO) released guidelines on the care and treatment of HIV and viral hepatitis. The WHO guidelines recommended testing for these three viruses in the following populations: people who use drugs (PWUD), gay, bisexual, men who have sex with men (gbMSM) and incarcerated people. They note that the three viruses are not limited to these populations.

For more information: https://tinyurl.com/muhtu4r9

Hep C World News - Week of March 24, 2024

How to motivate liver disease candidates to make lifestyle changes

Copenhagen, Denmark - New research reveals that screening for liver fibrosis is linked to improved alcohol consumption, diet, weight and exercise in people at risk for liver disease. Scientists supported in part by the EU-funded LiverScreen project have found that when people are screened for liver fibrosis, they are more motivated to make improvements in their alcohol intake, diet, exercise and weight. This suggests that a screening programme could serve as a tool for the prevention, early detection and treatment of advanced fibrosis. As part of the study, researchers investigated 4 796 people living in Denmark at risk of alcohol-related or non-alcoholic fatty liver disease. They found that participation in a liver fibrosis screening programme leads to sustained improvements in lifestyle among individuals at risk for these diseases. Of the 4 796 participants, 1 850 were at risk for alcohol-related liver disease (ALD) and 2 946 for metabolic dysfunction-associated steatotic liver disease (MASLD). A total of 383 individuals – 10 % of the ALD group and 7 % of the MASLD group – screened positive for fibrosis. Having received lifestyle advice, participants completed questionnaires evaluating lifestyle changes at 1 week and 6 months, and a subgroup was re-examined at 2 years. In the ALD group, excessive drinking decreased from 46 % to 32 % at the 6-month mark. Only a small percentage – 15 % – reported increased drinking, without any differences between individuals who screened positive and those who screened negative. For participants with a high-risk alcohol use at baseline, a positive screening test predicted abstinence or decreased alcohol use after 6 months. After 2 years, excessive drinking dropped from 52 % to 41 % in a subgroup of 752 individuals and a positive screening test again predicted abstinence or decreased alcohol use. MASLD participants showed similar improvements in lifestyle at 6 months. An estimated 35 % improved their diet, 22 % exercised more, and 13 % reported a weight loss of 5 % or greater. Improvements in the MASLD group were most pronounced in participants who had screened positive. “This is to our knowledge the first study investigating global lifestyle changes after targeted, population-based screening for liver fibrosis across the spectrum of steatotic liver disease. Our study is unique, because we investigated 4796 at-risk individuals from the general population, have an 84% response rate, evaluate both short- and long-term changes, and assessed lifestyle risk factors …,” report the authors in their paper. “Our results indicate that screening for liver disease may act as an added motivation for patients to achieve better health,” the study authors supported by LiverScreen (Screening for liver fibrosis - population-based study across European countries) conclude. “The act of attending a screening program for liver fibrosis can therefore be seen as a catalyst for behavioural change, boosting existing motivation for lifestyle improvements.” 

For more information: http://tinyurl.com/22bxedbk

Hep C World News - Week of March 17, 2024

Mike Tyson urges Biden to free thousands locked up over cannabis

Washington, DC - The former heavyweight boxing champion Mike Tyson has urged Joe Biden to follow through on his commitment to “correct our country’s failed approach to marijuana” and give clemency to the thousands of nonviolent cannabis offenders still languishing in federal lockups. “President Biden has the power to effect real change – he can right these wrongs and grant clemency to those who are sitting in prison for cannabis offenses,” Tyson told the Guardian. “We know the failed war on drugs was wrong and no one should be sitting in jail for cannabis. It’s time our country moves forward and end cannabis prohibition once and for all.” Legal cannabis sales in the US could soon reach $40bn annually. And campaigners say it is an injustice that more than 2,000 people – overwhelmingly people of color – are in federal jails sentenced for conduct that today is essentially legal in almost half of the country, with recreational cannabis legal in 24 states. About 30,000 more are in state penitentiaries for non-violent cannabis offenses, activists say, with data patchy. Biden doesn’t have the power to pardon those offenders, but Tyson pleaded with the president to pressure those states to do so. Biden has been accused of misleading voters in his messaging over his pardon for people convicted of simple marijuana possession offenses, in line with his campaign promise to decriminalize cannabis. “No one should be in jail just for using or possessing marijuana,” he said in October 2022. However, as of nine months earlier, “no offenders sentenced solely for simple possession of marijuana remained in the custody of the Federal Bureau of Prisons”, according to the US Sentencing Commission. (Those who remain in prison face charges including drug trafficking.) In a video for Reeform, a campaigning cannabis brand founded by Weldon Angelos, who served a 13-year prison sentence for selling less than $1,000 worth of cannabis before he was granted clemency in 2016, Tyson said it beggared belief that people were doing “murderers’ time” for trafficking a “mild medicine”. The White House will receive a letter on Tuesday penned by Tyson, a cannabis advocate and entrepreneur, which says it is high time the authorities reconcile with communities, including poor people and people of color, who have paid the heavy cost of the US’s so-called drug war.  

For more information: http://tinyurl.com/yjvn2f5n

Hep C World News - Week of March 10, 2024

There's a new boogeyman in town - Nitazenes 

Cleveland, OH - Move over fentanyl! There's a new boogeyman in town. At least that's what you might be hearing from the news. And if you haven't already heard the word "nitazenes" then you can expect to soon. Nitazenes are a class of synthetic opioids, also known as the benzimidazole opioids, which have received more and more attention as they are being detected with increasing frequency in street drugs and overdoses. Media coverage has primarily focused on nitazenes being "more potent than fentanyl," and a cause for concern in our ongoing overdose crisis. Make no mistake, fentanyl continues to drive the overwhelming majority of overdose deaths in the U.S. and the rest of North America, and so far, nitazenes have primarily been detected in drug samples with fentanyl. While detection seems to be increasing, it remains unclear what their true prevalence is in the drug supply because testing for nitazenes is limited and they are still not routinely tested for in overdose deaths. As detection capabilities are expanded, we can expect to see an increase in overdoses involving nitazenes, and we can prepare for this drug class in the supply without reinventing the wheel. Nitazenes themselves are not entirely new. They were developed in the 1950sopens in a new tab or window as potential pain medications, but they were never approved or used medically. They are also not used in veterinary medicine. Because of this, there is limited human data on their effects, not to mention that many of the nitazenes now being detected are completely novel drugs. However, the potency across the class is highly variable opens in a new tab or window: they can be significantly more potent than fentanyl and can have significantly longer-lasting effects. Meanwhile, other nitazenes are less potent than fentanyl. Isotonitazene -- a member of the nitazene class -- was first detected in drugs in the U.S and overdose victims in Canada and Europe in 2019opens in a new tab or window. Since then, 20 total nitazenes have been identified in street drugs with increasing frequency. They are Schedule I drugs in the U.S., meaning any possession or use is considered illegal. In areas of North America where drug sample testing is more widely employed and available, the prevalence of nitazene-positive samples actually seems to be low, and they seem to have possibly decreased over time in much the same way that many fentanyl analogues (which had also previously showed up in the drug supply) were ultimately replaced once more with fentanyl. This is not necessarily reassuring given limitations in testing, increases in fentanyl purity, and presence of other unpredictable substances like benzodiazepines and xylazine. In Europe, where fentanyl has not been widespread, there is more concern that nitazenes are on the rise as they have recently been detected in multiple countries and multiple different drug products. While fentanyl doesn't seem to be going away anytime soon in North America, Europe has the potential for nitazenes to become more widespread and cause more problems. This is because their appearance in the European drug market coincides with reduced supply of heroin, which had still been the primary street opioid there -- this situation is similar to the conditions that led to the rise of fentanyl in North America. With action already taken against Europe's heroin supply, the demand for opioids will most likely lead to replacement with synthetic alternative(s). Given the singular focus on supply-side interventions, any success at destroying the fentanyl supply should also be expected to carry similar risk for replacement with something new and something potentially worse.

For more information: http://tinyurl.com/3fda3psc

Hep C World News - Week of March 3, 2024

WHO hepatitis C elimination targets: the global equity challenge

Geneva, Switzerland - In 2016, the WHO Global Health Sector Strategy on Viral Hepatitis targeted an 80% reduction in new hepatitis C virus (HCV) infections by 2030, from 2015 levels. Currently, there are 58 million people living with HCV, a reduction of 18% from the 71·1 million people that were living with HCV in 2015. Only 11 countries are currently on track to reach HCV elimination targets by 2030. HCV elimination targets will not be realised globally at present treatment rates. Currently, for every person treated, two more people are infected. We estimated that the global number of people treated would need to increase from 754 000 per year to 7·2 million per year for WHO elimination targets to be achieved. Identifying and addressing barriers to HCV treatment is an issue of global health equity. Of the 111 countries with available data, high-income countries had diagnosed 45% of people with HCV in 2020, but only 5% of these people were treated. Low-income countries had diagnosed 16%, and treated less than 1% of people with HCV. The consequence of inequality in access to HCV treatment is that, while some countries have been successful in managing their local epidemics, the global HCV epidemic is not being adequately addressed. According to the 2022 WHO Global Health Sector Strategies global targets, by 2025, 60% of people with HCV should be diagnosed, and 50% should be treated. These targets might be achievable in high-income countries where 45% of people already know their HCV status; however, such targets are challenging for low-income and middle-income countries where testing and treatment are not readily available. In 2014, direct-acting antivirals (DAAs) advanced the efficacy and safety of HCV treatment, but their cost remains a barrier to universal HCV treatment access. Initial 12-week courses of DAAs ranged between US$66 400 and $84 000, with sofosbuvir making a record $2·3 billion in sales within the first quarter of 2014. The cumulative revenue for pharmaceutical companies for HCV drugs between 2009 and 2022 was approximately $109 billion. DAA costs have since decreased due to factors such as patent opposition, joint procurement, and voluntary licenses.  Achieving HCV elimination will require a substantial increase in treatment rates. If all 58 million people with HCV were treated with generic sofosbuvir–daclatasvir for US$40, HCV could be eliminated globally for $2·3 billion, preventing 263 000 deaths annually. This $2·3 billion equates to 2% of the $109 billion in HCV drug sales between 2009 and 2022. However, DAA price reductions are a necessary, but insufficient, component of HCV elimination. Coordinated test and treat strategies are critical to improve retention in care, and sociocultural and judicial barriers must be addressed. The future challenges will be to upscale screening programs and mobilize price reductions in a globalized way to achieve widespread and equitable HCV treatment access that is not isolated to high-income countries.

For more information: http://tinyurl.com/26mkpyx8

Hep C World News - Week of February 25, 2024

Women with concurrent MASLD, alcohol-related liver disease have 83% higher risk for death

Los Angeles, CA - Women with concurrent metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease had an 83% greater risk for all-cause mortality than men and those with ALD alone had 160% greater risk, data showed. “Steatotic liver disease is a major and increasingly prevalent condition that is likely an underlying precursor to many conditions, including those involving the heart,” Susan Cheng, MD, MPH, lead study author and director of the Institute for Research on Healthy Aging at Smidt Heart Institute, said in a Cedars-Sinai press release. “We are paying even more attention to steatotic liver disease because we are seeing how it tracks closely with established cardiovascular risk factors such as hypertension, high cholesterol and diabetes.” Using the National Health and Nutrition Examination Survey III (1988-1994), Cheng and colleagues analyzed data from 10,007 adults (mean age, 42 years; 50.3% women) to investigate the prevalence, risks and mechanisms of steatotic liver disease among women vs. men. Of those included, 1,461 had MASLD, 225 had MASLD and ALD (MetALD) and 105 had ALD. Data included ultrasonographic measures of hepatic steatosis, cardiometabolic risk factors and self-reported alcohol intake. According to results published in the Journal of Hepatology, there were significant differences in MASLD, MetALD and ALD prevalence among men (18.5%, 3.2% and 1.7%, respectively) vs. women (10.3%, 1.2% and 0.3%). Over a median follow-up of 26.7 years, there were 2,496 deaths. Multivariable-adjusted survival analysis showed MASLD was not significantly linked with all-cause mortality among men or women; however, MetALD was associated with a 83% higher risk for all-cause mortality among women (HR = 1.83; 95% CI, 1.29-2.57) but not men. Further, ALD was significantly associated with all-cause mortality among both sexes, with a higher magnitude among women (HR = 3.49; 95% CI, 1.86-6.52) compared with men (HR = 1.89; 95% CI, 1.42-2.51). “These findings are especially concerning in the context of the COVID-19 pandemic, during which alcohol use and related death, particularly in women, has increased,” Alan Kwan, MD, a research instructor in the department of cardiology at Cedars-Sinai who also worked on the study, said in the release. 

For more information: http://tinyurl.com/jjpjxk64

Hep C World News - Week of February 18, 2024

Why is the opioid addiction problem getting worse?

New York, NY - Opioid addiction doesn’t get as many headlines as it used to, but the crisis is as bad as ever. It doesn’t have to be. Decades into the deadliest drug overdose epidemic in American history, people are dying at higher rates than ever. Between 2017 and 2021, the number of overdose deaths involving opioids jumped from 47,600 to 80,411 — many more Americans than are killed each year by guns or cars. The surge has been largely driven by powerful synthetics like fentanyl, an opioid 50 times more potent than heroin.  Provisional data from the Centers for Disease Control and Prevention show nearly as many opioid-involved overdose deaths in 2022, at 79,770. Overdoses in Black, American Indian, and Latinx communities have been rising even faster, widening the mortality gap between white people and people of color. In 2020, Black men 65 and older died of overdoses at seven times the rate of white men in the same age range.  Meanwhile, the number of Americans struggling with opioid addiction remains staggering. In 2022, 6.1 million people 12 and older had an opioid use disorder, according to the Substance Abuse and Mental Health Services Administration’s most recent annual survey, while 8.9 million reported misusing opioids within the past year.  

Read the complete article, published by VOX: http://tinyurl.com/2y9uwt52

Hep C World News - Week of February 11, 2024

Overdose mortality incidence and supervised consumption services in Toronto

Toronto, ON - Supervised consumption services (SCS) prevent overdose deaths onsite; however, less is known about their effect on population-level overdose mortality found a study that was that was recently published in The Lancet. Researchers here aimed to characterize overdose mortality in Toronto, ON, Canada, and to establish the spatial association between SCS locations and overdose mortality events. For this ecological study and spatial analysis, we compared crude overdose mortality rates before and after the implementation of nine SCS in Toronto in 2017. Data were obtained from the Office of the Chief Coroner of Ontario on cases of accidental death within the City of Toronto for which the cause of death involved the use of an opiate, synthetic or semi-synthetic opioid, or other psychoactive substance. We assessed overdose incident data for global spatial auto-correlation and local clustering, then used geographically weighted regression to model the association between SCS proximity and overdose mortality incidence in 2018 and 2019. The researchers included 787 overdose mortality events in Toronto between May 1, 2017, and Dec 31, 2019. The overdose mortality rate decreased significantly in neighborhoods that implemented SCS (8·10 deaths per 100 000 people for May 1–July 31, 2017, vs 2·70 deaths per 100 000 people for May 1–July 31, 2019; p=0·037), but not in other neighborhoods. In a geographically weighted regression analysis that adjusted for the availability of substance-use-related services and overdose-related sociodemographic factors by neighborhood, the strongest local regression coefficients of the association between SCS and overdose mortality location ranged from −0·60 to −0·64 per mile in 2018 and from −1·68 to −1·96 per mile in 2019, suggesting an inverse association. They found that the period during which SCS were implemented in Toronto was associated with a reduced overdose mortality in surrounding neighborhoods. The magnitude of this inverse association increased from 2018 to 2019, equaling approximately two overdose fatalities per 100 000 people averted in the square mile surrounding SCS in 2019. Policy makers should consider implementing and sustaining SCS across neighborhoods where overdose mortality is high. 

For more information: http://tinyurl.com/3ex8zsdj

Hep C World News - Week of February 4, 2024

Alcohol, opioids most common causes of substance use-related heart disease deaths

Redlands, CA - Substance use-related CVD deaths increased at an average of 4% per year from 1999 to 2019, with alcohol and opioids the most common contributors, despite an overall reduction in CVD mortality in the U.S. during the same period, data show. In a large database analysis of CDC death data published in the Journal of the American Heart Association, researchers also found that the increase in substance use-related CVD age-adjusted mortality rate has particularly accelerated since 2012. “Despite drops in overall CVD disease deaths from 1999 to 2019, CVD deaths in which substance use was cited as a contributing factor increased an average of 4% per year, with the death rate accelerating to 6.2% from 2012 through 2019,” Dmitry Abramov, MD, a cardiologist and associate professor of medicine at Loma Linda University Health in Redlands, California, told Healio. “Prominent increases in CVD deaths associated with substance use were most notable among women, American Indian or Alaskan individuals, younger individuals, rural area residents, and users of cannabis and psychostimulants. However, increases were seen across the board among all of the studied substances and among all studied demographics, which highlights the significant public health burden of substance use as a contributor to CVD death.” Abramov and colleagues analyzed deaths occurring within the U.S. related to CVD and substance use (excluding smoking or tobacco use) from the CDC WONDER database. Researchers calculated crude, age-adjusted mortality rates per 100,000 population, annual percent change, and average annual percent changes from 1999 to 2019. From 1999 to 2019, there were 51,998,560 deaths in the U.S., of which 29,455,193 deaths were related to CVD in people aged 25 years and older. Of those deaths, 2.2% listed substance use as a concomitant cause of death. Of the deaths attributed to substance use and CVD, 75.6% were men; 70.6% were white and 65% were related to alcohol use. Researchers found that the age-adjusted mortality rates per 100,000 population were more pronounced among men (22.5; 95% CI, 22.5-22.6) than women, more pronounced among American Indian or Alaska Native people (37.7; 95% CI, 37-38.4) than other races or ethnicities and more pronounced among those living in rural areas (15.2; 95% CI, 15.1-15.3) than those living in urban areas. Assessing substance use category, age-adjusted mortality rate per 100,000 population was highest for alcohol-related CVD death (9.09; 95% CI, 9.07-9.12), followed by opioids (2.04; 95% CI, 2.03-2.06), cocaine (1.45; 95% CI, 1.44-1.46) and stimulants (0.95; 95% CI, 0.94-0.96). The overall substance use-related CVD age-adjusted mortality rates increased from 9.9 (95% CI, 9.8-10.1) in 1999 to 21.4 (95% CI, 21.2-21.6) in 2019, with an average annual percent change of 4% (95% CI, 3.7-4.3).  The increases in substance use-related CVD average annual percent change were greatest among women (4.8%; 95% CI, 4.5-5.1), American Indian or Alaska Native people (5.4%; 95% CI, 4.4-6.4), younger adults aged 25 to 39 years (5.3%; 95% CI, 3.9-6.6), those living in rural areas (5%; 95% CI, 4.6-5.4) and people who used cannabis and psychostimulants (12.7%; 95% CI, 10.9-14.5). “Rising rates of CVD mortality associated with substance use should lead to additional public health efforts to support comprehensive evaluation and management of substance use in the U.S.,” Abramov told Healio. “That includes clinician and patient education, as well as attention to socioeconomic factors that contribute to substance use. Additional public health efforts are important to both reduce substance use and to reverse the trends in CVD deaths associated with substance use and will hopefully lead to further reduction in the overall burden of CVD.” 

For more information: http://tinyurl.com/4ak8v8xk

Hep C World News - Week of January 28, 2024

ACG publishes new guideline for management of alcohol-associated liver disease

Louisville, KY - A new clinical guideline published in the American Journal of Gastroenterology underscored the need to overcome barriers to alcohol use disorder treatment and expand multidisciplinary care for patients with alcohol-associated liver disease. “I think the most important reason why the American College of Gastroenterology wanted to revise this guideline is there has been impetus and recognition that control of the risk factor of alcohol use disorder seems to be the way forward in managing and controlling the magnitude and burden of this disease,” Ashwani K. Singal, MD, MS, FACG, FAASLD, AGAF, guideline author and professor of medicine at the University of Louisville, told Healio. “The second reason is that we wanted to bring out a stronger recommendation to consider early liver transplantation in these patients.” Singal continued: “Further, although there are no currently approved pharmacological therapies for alcohol-associated liver disease and alcohol-associated hepatitis, there are promising therapies on the horizon with a potential in the management of these patients.” To develop a practice guideline for the management of patients with alcohol-associated liver disease (ALD), ACG experts performed a Grading of Recommendations, Assessment, Development and Evaluation analysis of data based on a patient-intervention-comparison-outcome format. The analysis resulted in 35 key concepts or statements and 22 recommendations, which include the following. Alcohol consumption should be avoided among those with underlying obesity or chronic hepatitis C and hepatitis B virus infection. Those undergoing or with a history of gastric bypass should avoid heavy alcohol use. Given the associated higher risk for cirrhosis, heavy alcohol users should abstain from any tobacco use. Adults with suspected unhealthy alcohol use should undergo screening with tools such as the Alcohol Use Disorders Identification Test-Consumption tool. Among those with compensated ALD and alcohol use disorder (AUD), baclofen is recommended and other treatment options include acamprosate, naltrexone, gabapentin or topiramate. Experts suggest against use of disulfiram for treatment of AUD along any spectrum of ALD. Pentoxifylline should not be used in those with severe alcohol-associated hepatitis (AH), nor should universal administration of prophylactic antibiotics be used in hospitalized patients. Conversely, corticosteroid therapy and adjuvant IV N-acetylcysteine is recommended for those with severe AH. Patients with severe AH and high risk for death who are unresponsive to medical management may undergo early liver transplantation according to regional and institutional protocols. Integrated multidisciplinary care models that incorporate behavioral interventions and/or pharmacotherapy should be offered for those with ALD and AUD. “What gastroenterologists and hepatologists need to recognize is to not only screen these patients for alcohol use disorder but also treat them effectively,” Singal said. “Because these patients have liver disease from alcohol use, they’re struggling not only from liver disease and their complications, but also from another disease of alcohol use disorder. We need to take a multidisciplinary integrated care approach for these patients where patients are seen not only by a liver doctor but also comprehensively by an addiction expert, including a counselor, social worker and psychiatrist.” Singal continued: “Comprehensive holistic approach by both specialists overcomes several barriers to receiving care for alcohol use disorder, with a potential for improving long-term outcomes. Integrated approach is also recommended to design future clinical trials for drug development with evaluation of outcomes targeted at liver disease as well as on alcohol use.” 

For more information: http://tinyurl.com/2s4as4r3

Hep C World News - Week of January 21, 2024

New report to advance global HCV elimination efforts through point-of-care 

Paris, France - The International Network on Health and Hepatitis in Substance Users (INHSU), in collaboration with the Coalition for Global Hepatitis Elimination (CGHE), FIND, The Kirby Institute, UNSW, and Clinton Health Access Initiative (CHAI), announces the release of a comprehensive report stemming from the INHSU Hepatitis C Point-of-Care Testing Forum, held during the Global Hepatitis Summit in Paris in April 2023. Despite advances in treatment, an estimated 57 million people are living with chronic hepatitis C infection globally, with 290,000 people dying from HCV-related cirrhosis and liver cancer each year. Scaling up testing and utilizing innovative testing methods are integral if the World Health Organization’s (WHO) 2030 elimination targets are to be met.  This report, developed in response to the urgent need for effective strategies to combat the global burden of HCV, explores the underutilized promise of point-of-care testing in simplifying diagnosis, improving access to treatment, and ultimately reducing the prevalence of HCV. Emma Day, Executive Director of INHSU, emphasized the critical importance of this collaborative effort, stating, “The insights shared at the INHSU Hepatitis C Point-of-Care Testing Forum highlight the potential of point-of-care testing in transforming the landscape of HCV diagnosis and care. By breaking down barriers, we can significantly enhance our efforts towards achieving global HCV elimination goals.” Following the Forum, the report draws on experience from key stakeholders to outline barriers and solutions for increasing access to point-of-care testing across five key areas within a health systems framework. The report underscores the urgent need for action to address challenges in these five key areas and provides practical solutions for implementation alongside real-world examples of successful Point-of-Care programs from Catalonia, Iran, Denmark and more.  It is a valuable resource for policymakers, healthcare professionals, and organisations committed to advancing global HCV elimination goals. 

For more information: http://tinyurl.com/2ussykv5

Hep C World News - Week of January 14, 2024

Developments in hepatitis care: New CDC recommendations and more

Atlanta, GA - As viral hepatitis continues to be a major health concern in the infectious disease field, recent research has highlighted the importance of testing and treatment. A nationally representative survey revealed that of the more than 2 million people with current hepatitis C virus infection, only 68% are aware of their infection.  In new guidance, the CDC recommended that the two-step testing process for hepatitis C virus be completed in one visit, eliminating the need for multiple visits, which often leads to incomplete testing.  Testing for HIV, hepatitis B, and hepatitis C increased among U.S. Medicaid enrollees initiating treatment for opioid use disorder. However, a recent study showed approximately three-quarters of enrollees were not tested for each condition.  Hepatitis C cure rates ‘jarringly low’ as many lack access to treatment An analysis of data from 2013 to 2022 showed that only 34% of people diagnosed with hepatitis C in the United States were cured or cleared of the virus, with many still lacking access to highly effective treatments.

For more information: http://tinyurl.com/4rf6yz3a

Hep C World News - Week of January 7, 2024

Swiss capital Bern considers legal cocaine project 

Zurich, Switzerland - Switzerland's capital is examining a pilot scheme to allow the sale of cocaine for recreational use - a radical approach to the war on drugs that is not thought to have been tried elsewhere. Parliament in Bern has supported the idea, which still needs to overcome opposition from the city government and will also require a change in national law. Drugs policy around the world is evolving, with the U.S. state of Oregon, for example, decriminalising possession of small amounts of cocaine in 2021 in favour of drug treatment. Many European countries, including Spain, Italy and Portugal, no longer have prison sentences for possession of drugs including cocaine, although nowhere has gone as far as the proposal under discussion in Bern. Switzerland is re-examining its stance on the drug after some politicians and experts criticised complete bans as ineffective, with the proposal - currently in its early stages - following trials now under way to permit the legal sale of cannabis. "The war on drugs has failed, and we have to look at new ideas," said Eva Chen, a member of the Bern council from the Alternative Left Party who co-sponsored the proposal. "Control and legalisation can do better than mere repression." Wealthy Switzerland has one of the highest levels of cocaine use in Europe, according to the levels of illicit drugs and their metabolites measured in waste water, with Zurich, Basel and Geneva all featuring in the top 10 cities in Europe. Swiss cities, including Bern, are also showing increasing usage, while prices of cocaine have halved in the last five years, according to Addiction Switzerland, a non-governmental organisation. "We have a lot of cocaine in Switzerland right now, at the cheapest prices and the highest quality we have ever seen," said Frank Zobel, deputy director at Addiction Switzerland. "You can get a dose of cocaine for about 10 francs these days, not much more than the price for a beer." Bern's education, social affairs and sport directorate is preparing a report on a possible cocaine trial, although this does not mean it will definitely take place. "Cocaine can be life-threatening for both first-time and long-term users. The consequences of an overdose, but also individual intolerance to even the smallest amounts, can lead to death," the Bern government said. Bern parliament member Chen said it was too early to say how a pilot scheme would develop, including where the drug would be sold or how it would be sourced. "We are still far away from potential legalisation, but we should look at new approaches," Chen said. "That is why we are calling for a scientifically supervised pilot scheme trial." For a trial to take place, parliament would have to amend the law banning the recreational use of the drug. The decision could come in a matter of years, or earlier if the current cannabis schemes - where the drug is on sale at pharmacies - show successful results, political experts said. Any legalisation would be accompanied by quality controls and information campaigns, Chen said, with the approach also reducing a lucrative criminal market. Experts are divided, with even those in favour of the trial concerned about the potential dangers. "Cocaine is one of the most strongly addictive substances known," said Boris Quednow, group leader of the University of Zurich's Centre for Psychiatric Research. He said its risks were in a completely different league to alcohol or cannabis, citing links to heart damage, strokes, depression and anxiety. On the other hand, Thilo Beck, from the Arud Zentrum for Addiction Medicine, the largest centre for addiction medicine in Switzerland, said it was time for a more "grown up" policy towards cocaine. "Cocaine isn't healthy - but the reality is that people use it," said Beck. "We can't change that, so we should try to ensure people use it in the safest, least damaging way." Leo, a cocaine user from Geneva, said legalising the drug would make treatment easier, as well as reduce violence and crime linked to supply. It would also make it easier to control the quality of the drugs on sale. "Prohibiting drugs doesn't give good results in terms of health policies and prevention," Leo told Reuters. "On the contrary, it looks like countries who chose to legalize it or to depenalize drugs, have better results in terms of prevention and global health policies. "Switzerland has been courageous in its policies with other drugs, so I think the next stage should be the legalisation of cocaine." 

For more information: http://tinyurl.com/4x4d2n2f