Tag Archives: hepatitis C

The world needs a healthier, rights-based approach towards people who use drugs

DrugsParty

The world is failing to protect the health and human rights of people who use drugs.

As a result, people who use drugs, especially people who inject drugs, have been isolated and denied the means to protect themselves from HIV, hepatitis C, tuberculosis and other infectious diseases.

Among the estimated 12 million people who inject drugs globally, one in 10 is living with HIV. From 2010 to 2014, there was no decline in the annual number of new HIV infections among people who inject drugs, in contrast to the global trend of declining new HIV infections.

The evidence is overwhelming. The world needs a fresh approach towards people who use drugs that is people-, rights- and health-centered.

Story via 
TheWorldPost

In a new report, Do no harm: health, human rights and people who use drugs, UNAIDS presents the evidence for what works to reduce the impact of HIV and other harms associated with drug use. Countries that have shifted their focus away from laws and policies that are harmful to people who use drugs and that have increased investment in harm reduction programs have reduced new HIV infections and improved health outcomes.

For example, investment in needle-syringe distribution and opioid substitution therapy has proved effective at reducing the impact of the AIDS epidemic among people who inject drugs in several countries, including China, the Islamic Republic of Iran and the Republic of Moldova.

China’s free voluntary methadone program piloted in the early 2000s now serves more than 180 000 people. People who inject drugs represented less than 8% of people newly diagnosed with HIV in the country in 2013, compared with 43.9% in 2003. In prisons in the Islamic Republic of Iran, health clinics provide integrated services for the treatment and prevention of sexually transmitted infections and for injecting drug use and HIV, and new HIV cases among people who inject drugs fell from a peak of 1897 in 2005 to 684 in 2013. In the Republic of Moldova, the proportion of prisoners living with HIV having access to antiretroviral medicines has increased from 2% in 2005 to 62% in 2013.

Some countries, such as Australia, the Netherlands, Portugal and Switzerland, have de-penalized the possession and use of small quantities of drugs for personal use, encouraging people who inject drugs to access strengthened harm reduction programs.

UNAIDS would like to see a global adoption of a people-centered, public health and human rights based approach to drug use.

The world cannot continue to ignore what works.

In the coming weeks, the United Nations General Assembly will have two opportunities to consider the weight of evidence supporting a change in approach. This week’s United Nations General Assembly Special Session on the World Drug Problem provides an opportunity to refocus international drug policies on their original goal—the health and well-being of humankind. A few weeks later, from 8 to 10 June, the General Assembly will meet again for the High-Level Meeting on Ending AIDS, which must translate commitments to leave no one behind in the AIDS response into measurable progress for people who inject drugs.

There is a unique opportunity to begin to treat people who use drugs with dignity and respect, to provide people who use drugs with equal access to health and social services, to greatly reduce the harms of drug use and to take a step towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.

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More than two million people are co-infected with HIV and hepatitis C

An estimated 2.3 million people living with HIV are co-infected with hepatitis C virus (HCV) globally, a new study by the University of Bristol and the London School of Hygiene & Tropical Medicine has found.

Story via University of Bristol
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Of these, more than half, or 1.3 million, are people who inject drugs (PWID). The study also found that HIV-infected people are on average six times more likely than HIV-uninfected people to have HCV infection, pointing to a need to improve integrated HIV/HCV services.

HIV and HCV infections are major global public health problems, with overlapping modes of transmission and affected populations. Globally, there are 37 million people infected with HIV, and around 115 million people with chronic HCV infection. However, very little was known about the extent of HIV/HCV coinfection prior to this study, which was the first global study of its kind.

Sponsored by the World Health Organisation (WHO), the study was published online in The Lancet Infectious Diseases on February 24. WHO commissioned the study to inform an update of its guidelines on screening of coinfections and initiation of antiretroviral therapy, and to inform regional and national strategies for HCV screening and management.

The study systematically reviewed 783 medical studies from worldwide sources to build the first global estimates on the prevalence of HIV/HCV co-infection (measured by HCV antibody) as a public health problem.

Dr Philippa Easterbrook, from WHO’s Global Hepatitis Programme said: “The study shows that not only are people with HIV at much higher risk of HCV infection, groups such as people who inject drugs have extremely high prevalence of HCV infection – over 80 Per cent. There is a need to scale-up routine testing to diagnose HCV infection in HIV programmes worldwide, especially among high-risk groups, as the first step towards accessing the new, highly curative HCV treatments.”

Dr Lucy Platt, lead author and senior lecturer from the London School of Hygiene & Tropical Medicine said: “Despite a systematic search of published and unpublished literature, estimates were identified in only 45 per cent of countries and the study quality was variable. Improvement in the surveillance of HCV and HIV is imperative to help define the epidemiology of coinfection and inform appropriate policies for testing, prevention, care and treatment to those in need. This is especially the case in countries with growing populations of PWID and also in sub-Saharan Africa where the burden of coinfection is large due to high burden of HIV.”

Professor Peter Vickerman, from the University of Bristol’s School of Social and Community Medicine said: “This study shows how important injecting drug use is in driving the epidemic of HCV in people with HIV infection, especially in eastern European and central Asian countries. It also shows the need to scale up prevention interventions, such as needle and syringe programmes and opioid substitution therapy, as well as access to HIV and HCV treatment, to reduce morbidity and new infections.”

The study focusses on prevalence of HCV antibodies that measures exposure to HCV but not active infection. Measuring the presence of active virus and the need for treatment requires an additional more costly viral test, which very few of the reviewed studies had done. Around 20-30 per cent of people exposed to HCV and found positive with antibody will clear the virus.

The study shows the greatest burden of HIV/HCV coinfection in Eastern Europe and central Asia, where there are an estimated 607,700 cases (27 per cent of all cases), particularly among PWID. The sub-Saharan African region accounts for 19 per cent of all cases, with 429,600 cases, due to high burdens of HIV.

The researchers included studies with estimates of HCV coinfection in the main HIV population, as well as sub-groups of PWID, men who have sex with men, heterosexually exposed and pregnant women, other high-risk groups and the general population. Studies were eligible if they included a minimum of 50 individuals.

The search focused on published medical literature, and excluded samples drawn from populations with other comorbidities, or undergoing interventions that put them at increased risk of coinfection.

Paper: ‘Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis‘ by L Platt et al in The Lancet Infectious Diseases

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Two interferon-free regimens have high hepatitis C cure rates for people with HIV

David Wyles and Susanna Naggie presenting at CROI 2015. Photo by Liz Highleyman, hivandhepatitis.com.

David Wyles and Susanna Naggie presenting at CROI 2015. Photo by Liz Highleyman, hivandhepatitis.com.

Story via NAM (@aidsmap)

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NAM is an award-winning, community-based organisation, which works from the UK. They deliver reliable and accurate HIV information across the world to HIV-positive people and to the professionals who treat, support and care for them.

A pair of two-drug, 12-week regimens containing neither interferon nor ribavirin cured hepatitis C for more than 95% of people with HIV and hepatitis C co-infection, according to two studies presented to CROI this week.

The first regimen was sofosbuvir plus ledipasvir (Harvoni coformulation), produced by Gilead. The second was sofosbuvir (Sovaldi) plus daclatasvir (Daklinza), with the latter drug produced by Bristol-Myers Squibb. Ledipasvir and daclatasvir are both NS5A inhibitors.

In both studies, the response rates in people with HIV and hepatitis C co-infection were as high as those for people with hepatitis C mono-infection in other trials. This supports recent hepatitis C treatment guidelines recommending that HIV-positive and HIV-negative people should be treated in the same way for hepatitis C.

For sofosbuvir plus ledipasvir (Harvoni), 335 people with co-infection took part in the open-label, non-randomised study. The trial had broad inclusion criteria and included more difficult-to-treat groups such as prior non-responders and people with liver cirrhosis than many other studies. Almost all had genotype 1, more than half were treatment-experienced and three-quarters had unfavourable IL28B gene variants. All were taking HIV treatment and most had an undetectable viral load.

Participants took a once-daily tablet for twelve weeks, with an additional twelve weeks follow-up to assess sustained virological response (SVR12), or continued undetectable hepatitis C. The overall SVR12 rate was 96%, similar to that in people with mono-infection. Having taken treatment before, having liver cirrhosis or NS5A resistance variants made little difference to the cure rate.

However, SVR12 rates were slightly lower in participants who were black. This had not been observed in mono-infection studies. One possible explanation, which will be explored, is an influence of genetics on drug response when both ledipasvir and antiretrovirals are used.

For sofosbuvir (Sovaldi) plus daclatasvir (Daklinza), 151 previously untreated individuals with co-infection were randomised to either eight or twelve weeks of the regimen, while 52 treatment-experienced individuals all took it for twelve weeks. Almost all participants were taking HIV treatment and had an undetectable viral load.

While two-thirds had hepatitis C genotype 1a, people with genotypes 2 to 6 were included – an advantage of daclatasvir is that it is active against multiple genotypes whereas ledipasvir is primarily active against genotype 1.

Participants randomised to take the once-daily tablets for eight weeks had poorer results (SVR12 76%), but the twelve-week course worked well – an SVR12 of 96% in people who had never taken treatment before and 98% in treatment-experienced individuals. Rates were similar across genotypes.

Both regimens studied were generally safe and well-tolerated.

Related links
Read this news story in full on aidsmap.com
View a webcast of Susanna Naggie presenting
View a webcast of David Wyles presenting

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Victims of contaminated NHS blood launch legal case

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Three men who contracted hepatitis C from contaminated imported blood have begun a legal case in the UK to challenge the compensation scheme.

They say it is unfair under disability discrimination because other patients in the same scandal have more favourable terms.

A new parliamentary report says around 7,500 patients were infected by imported blood products.

The government said it was considering improvements to the support system.

The three men, who are pursuing the case anonymously, claim the compensation scheme discriminates against them for having the hepatitis C virus, by paying them far less than patients with HIV receive.

Just under 6,000 people have been identified as having contracted hepatitis C and more than 1,500 others the virus which can lead to Aids, according to the report by the All-Party Parliamentary Group (APPG) on Haemophilia and Contaminated Blood.

More than 2,000 patients are thought to have died as a result of what has been called “the worst treatment disaster in the history of the NHS”.

“We believe it is clearly unlawful that one group of sufferers of a serious virus are treated differently.” – Rosa CurlingLawyer, Leigh Day

The report says thousands of people in the UK – many of them with haemophilia – were infected when they were treated with blood products imported from the US in the 1970s and 80s.

An independent inquiry report six years ago described the events as a “horrific human tragedy”.

Lawyer Rosa Curling, from the law firm Leigh Day, is representing the three men.

She told BBC News: “Both HIV and hepatitis C virus are life-threatening, life-long chronic conditions.

“These viruses both sadly have serious implications for those who carry them and, in a proportion of cases, will lead to the death of the patient.

“We believe it is clearly unlawful that one group of sufferers of a serious virus, contracted through the same NHS disaster, are treated differently on account of their disability.”

Successive governments have set up five different trusts to pay compensation to patients who were treated with the blood products.

Leigh Day says the discrimination goes beyond the lifetime of the victims, because dependents of those who die after contracting hepatitis C also receive lower payments.

The law firm has sent a detailed legal letter, asking the Health Secretary Jeremy Hunt to take action to correct the anomalies between the schemes.

The “letter before action” asks for a response within 14 days, before the possibility of further legal proceedings in the High Court through judicial review.

Ms Curling added: “Our clients wish to avoid litigation if this is possible.

“We want the chance to sit down with Jeremy Hunt, and obtain a commitment from him urgently to put things right.”

NHS treatment ‘devastated lives’

The APPG report highlights how most people with hepatitis C receive no ongoing payments, and they feel as though they have to beg for discretionary payments.

It recommends that payments to people infected through contaminated blood are at a level which lifts them out of poverty.

The issue is the subject of a backbench Commons debate today.

Liz Carroll, Chief Executive of the Haemophilia Society, said: “We speak to families affected by this scandal on a daily basis. Many are living in poverty, unable to pay everyday bills.

“Some live in damp conditions due to household repairs waiting to be funded, going back several years.

“Others are unable to prove they were infected by NHS treatment as their medical records are missing.

“NHS treatment devastated many lives. Now is the time to right this wrong and enable them to live with dignity.”

The Penrose Inquiry in Scotland is due to report imminently – this will be the first statutory inquiry looking into government culpability for the problem.

A Department of Health spokesperson said: “This is a very serious issue and we are looking at possible improvements to the system of providing support to those affected.

“For legal reasons we are unable to comment further on this specific case.”

Story via BBC

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[Egypt] Lawsuit targets army officials claiming HIV, Hepatitis C cure

Khaled Abou Bakr

Khaled Abou Bakr

High-profile lawyer Khaled Abou Bakr filed a lawsuit against army officials who promoted the controversial AIDS and Hepatitis C curing device in 2014, he announced on his Twitter account on Sunday.

The lawsuit was submitted on the grounds that they manipulated and failed to deliver their promise to the Egyptian people.

Abou Bakr demanded investigations against the first administrator of the so-called cure, Maj. Ibrahim Abdel Atty El-Sayed.

In his published complaint addressed to Prosecutor General Hisham Barakat, Abou Bakr said that in March, the army opened up the formal application route from patients. They promised to deliver the cure by 30 June followed by a six-month postponement notice on that date, but applicants have yet to see any results.

In February 2014, Abdel Atty announced he reached a cure for AIDS and Hepatitis C with 100% guaranteed results, saying: “I promise you that after today there will be no more Virus C patients.”

The announcement was made in the presence of then-defence minister Abdel Fattah Al-Sisi and former interim president Adly Mansour. Maj. Taher Abdullah, former head of the Armed Forces Engineering Authority (AFEA), spoke of medical and scientific achievement at the institution.

Shortly after, controversy erupted among scientists who expressed scepticism about the alleged cure. Egyptian scientist and former presidential advisor Essam Heggy told the press here were no scientific grounds for that cure, adding that “it would reflect badly on Egyptian scientists’ reputation across the globe”.

Army officials, journalists, activists and scientists exchanged back-and-forth accusations in the media following information that the army was launching investigations on the curing device. This would be done through an assigned scientific committee, although Abdullah denied this to the press.

Abou Bakr included Abdullah in his lawsuit, in addition to Dr Ahmed Moanes, a digestive and liver specialist at Ain Shams University’s Faculty of Medicine. The lawsuit said Moanes spoke on behalf of the committee expressing their scepticism, yet kept defending the cure in the media.

Some media reports said that Abdel Atty was neither scientifically certified nor given the military rank as an honorary title. Despite this, Abdel Atty appeared alongside a group of men on a televised programme to speak about his ‘invention’ in military uniforms. Activists said “he had embarrassed the army”.

Abou Bakr demanded compensation for the poor, helpless patients, who gave up their original treatment plans following high hopes in light of the army’s announced breakthrough.

Surgeon-turned-satirist Bassem Youssef repeatedly mocked the “invention” on his television show, often adding a digital time ticker on the screen to remind the audience of the army’s deadline promises.

A year before the army’s device invention was made public, it was reported that an army official had developed a detection device for Hepatitis C, known as C-fast. Scientists’ opinions from all over the world had were divided between confirmation that the device actually worked, has been tested and was a breakthrough, while others remained sceptical, according to interviews published by The Guardian in February 2013.

There are approximately 40,000 deaths from Hepatitis C and approximately 165,000 new cases in Egypt every year, according to remarks made in July 2014 by Dr Henk Bekedam, World Health Organization (WHO) representative in Egypt.

Story via Menafn.com

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Scientists Develop Nanoparticle Which Completely Destroys Hepatitis C

Estimates suggest over 250,000 people in the UK have been infected with hepatitis C, but eight out of 10 don’t know they have it because they have no symptoms. About 75% of these people go on to develop a chronic hepatitis.

Because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware they have a problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier.

Elsewhere in the world, hepatitis C is even more common – the World Health Organization estimates that three per cent of the world’s population (about 170 million people) have chronic hepatitis C and up to four million people are newly infected each year.

While there’s increasing progress towards finding a reliable vaccine, results can’t come soon enough. Now, researchers have developed a nanoparticle that effectively eradicates hepatitis C 100 per cent of the time.

Researchers from the University of Florida have developed what they call a “nanozyme”. Based around gold nanoparticles, these things have their surface coated with two biological agents. One is an enzyme that attacks and kills the mRNA which allows hep C to replicate, while the other is a short string of DNA which identities the disease and sends the enzyme off to kill it.

While current hep C treatments attack the same replication process, they only work on about 50 per cent of patients treated. In lab-based tests, reported in the Proceedings of the National Academy of Sciences, the Univeristy of Florida researchers showed that their approach was 100 per cent effective in both cell cultures and mice. They observed no side effects in the mouse models, either.

While it’s great news, such a treatment is some way off becoming available to patients any time soon. All targeted drugs have to be extremely carefully tested, as there’s always a risk that they could also end up targeting healthy parts of the body by accident. Given the current problems posed by hepatitis C, though, that testing can’t happen soon enough.

Original Articles via BBC, Gizmodo, PNAS & IEEE Spectrum

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Pill Targeting Hepatitis C Launched

A new pill that directly targets hepatitis C for the first time has been launched in the UK.

A new pill that directly targets hepatitis C for the first time has been launched in the UK

In clinical trials, adding Victrelis to standard therapy increased the number of chronic patients freed from the virus up to threefold.

Hepatitis C is a blood-to-blood infection that attacks the liver. It is commonly spread by injecting drug users sharing needles, body piercing and tattoos.

The virus can also be transmitted by blood transfusions, but donor screening has prevented this happening in the UK since 1991. Sexual transmission is extremely uncommon.

The infection is known as the “silent epidemic” because it may take decades to produce any symptoms. Ultimately, the virus can cause serious liver damage or liver cancer.

Around 216,000 people in the UK are believed to be chronically infected with hepatitis C but many do not know it.

Until now, licensed treatments have relied on boosting the immune system to fight the infection.

Victrelis, one of a class of drugs called protease inhibitors, is different because it attacks the virus directly.

Charles Gore, chief executive of the the Hepatitis C Trust charity, said: “Hepatitis C is called the silent epidemic because hundreds of thousands of people carry the virus yet the great majority have no idea they are infected.

“It can take decades for symptoms of hepatitis C to emerge and when they do, damage to the liver may have already occurred. Raising awareness of the condition and getting more people tested are critical, but we also need effective treatments once it is diagnosed.”

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Via Belfast Telegraph