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People with hepatitis C were more likely to be admitted to hospital as a result of SARS-CoV-2 infection but no more likely to die when compared to people without hepatitis C of a similar age, research from a US cohort of military veterans shows. As in other liver diseases, advanced liver fibrosis was a major risk factor for hospitalisation.

The findings are published in the journal Liver International.

Previous studies of the impact of COVID-19 on people with liver disease have shown that people with decompensated cirrhosis are at higher risk of death from COVID-19 but have not identified any relationship between hepatitis C infection and worse outcomes from COVID-19.

US researchers matched 975 people with chronic hepatitis C diagnosed with SARS-CoV-2 in 2020, with patients of similar age, sex and race.

People with hepatitis C were significantly more likely to be admitted to hospital within 14 days of a positive test for SARS-CoV-2 (24% vs 18.3%, p = 0.002) but no more likely to be admitted to an intensive care unit (13% vs 12.5%). People with hepatitis C did not have a higher risk of death after admission to hospital (6.6% vs 6.5%).

Sub-group analysis showed that age, sex, liver fibrosis and number of co-morbidities did not affect mortality. People with hepatitis C with more advanced liver disease were however more likely to be hospitalised and more likely to be admitted to an intensive care unit with COVID-19.

People with advanced fibrosis were more likely to be hospitalised, and infection with hepatitis C further increased this risk. The investigators say it is unclear why hepatitis C seemed to be an additional risk factor in patients with advanced fibrosis. More research is needed to identify if viral or host factors are responsible for raising the risk of poor COVID-19 outcomes in people with hepatitis C, the researchers conclude.

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COVID-19 has caused substantial disruption to viral hepatitis screening and treatment, a global survey finds, but has also led to improvements in laboratory capacity and telemedicine that will benefit future efforts to eliminate hepatitis B and C.

The Coalition for Global Hepatitis Elimination carried out a 53-question online survey of doctors and programme managers between August and December 2020. They asked about the impact of COVID-19 on service delivery and how respondents had participated in the COVID-19 response. They also asked about the measures adopted to safely deliver testing and treatment services, and any perceived benefits of the COVID-19 pandemic for hepatitis care.

Several hepatitis C specialists reported a decline in treatment numbers and the number of people tested for hepatitis C. Hepatitis B specialists less often reported substantial reductions in treatment numbers. Disruptions to the supply chain for diagnostics and drugs were also observed.

Hepatitis specialists were also diverted to COVID-19 testing or care. About one third reported that at least 25% of their time had been reallocated to COVID-19 work.

Image: Domizia Salusest | www.domiziasalusest.com

COVID-19 has affected hepatitis C screening and treatment for vulnerable groups in the United Kingdom, The Lancet reports.

But although testing has been reduced, innovations in testing have allowed testing to continue. Peer outreach organised by the Hepatitis C Trust has maintained links between people on treatment and clinical services, while drug and alcohol services have been able to deliver sampling kits for hepatitis C testing by post to maintain testing.

However, pressure on clinical services during the second wave of COVID-19 has caused many staff in hepatitis C services to be redeployed to COVID-19. Testing in prisons has also suffered due to the need to limit prison visiting and circulation within prisons.

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Hepatitis C treatment reduces the risk of subsequent stroke or heart attack by between 25 and 35%, a meta-analysis of studies published in the Journal of Viral Hepatitis shows.

People with hepatitis C have a higher risk of cardiovascular disease. A meta-analysis of 22 studies, published in 2016, found that hepatitis C raised the risk of cardiovascular events by 30% and the risk of stroke by 35%.

However, it has been unclear if curing hepatitis C reduces that risk, or if people cured of hepatitis C remain at higher risk of heart attack and stroke due to long-term damage caused by hepatitis C infection. Several studies have failed to find any effect of treatment on cardiovascular risk and it is unclear how treating and curing hepatitis C might lead to improved outcomes.

A systematic review of eleven studies found that any treatment for hepatitis C was associated with a 36% reduction in the risk of cardiovascular disease. Any treatment for hepatitis C reduced the risk of coronary artery disease by 27%. Any treatment reduced the risk of stroke by 26%. Five studies compared cardiovascular outcomes in people cured of hepatitis C and people who were not cured. Curing hepatitis C reduced the risk of any cardiovascular outcome by 26%.

The researchers speculate that curing hepatitis C may improve the functioning of blood vessels, which would lead to reduced blood pressure. Curing hepatitis C may also reverse or prevent diabetes, an important contributor to cardiovascular risk.

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The prevalence of hepatitis C in people who inject drugs has fallen modestly in England, Wales and Northern Ireland and sharply in Scotland since 2016, Public Health England reports.

Around one in four people who inject drugs in England, Wales and Northern Ireland has hepatitis C, and one in five in Scotland.

The surveys found that chronic hepatitis C infection prevalence had fallen from 29% in 2016 to 23% in 2019 in England, Wales and Northern Ireland. In Scotland, prevalence fell from 39% in 2015-2016 and 31% in 2017-2018 to 19% in 2019-2020.

The findings come from the annual Public Health England report on infections and injecting behaviour, published last month.

Public Health England says that the findings indicate a modest effect of the scale-up of direct-acting antiviral treatment but testing rates in people who inject drugs need to be improved.

However, transmission of hepatitis C and sharing of injecting equipment have not declined since 2016.

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People who use drugs achieved high rates of hepatitis C cure on direct-acting antiviral treatment despite ongoing drug and alcohol use, demonstrating that active drug use should not be a barrier to treatment, US researchers report in the journal Open Forum Infectious Diseases.

Active drug and alcohol use have disqualified people with hepatitis C in some settings from obtaining direct-acting antiviral treatment. But there is a lack of evidence to support this barrier.

Researchers at the University of Colorado recruited 60 people who were active drug users (predominantly marijuana and methamphetamine). They tested two electronic reminder methods to promote adherence to treatment. Participants in the study received a 12-week course of direct-acting antiviral treatment. Eighty-six per cent were cured of hepatitis C. Adherence to study medication was very high; participants took a median of 96% of doses. There was no difference in adherence rates according to reminder method.

“Our findings support expanding direct-acting antivirals to treat people who use drugs to eradicate hepatitis C virus and the use of technology-based measures to facilitate treatment uptake in this population,” the researchers conclude.

The Global Fund is currently developing its new strategy for the period 2023-2028. For the past 18 months, the World Hepatitis Alliance and partners have been advocating for the Global Fund to include more support for hepatitis services within their funding remit.

To develop the Global Fund strategy, a series of virtual partnership forums are taking place to get input from Global Fund stakeholders.

The World Hepatitis Alliance has developed a messaging guide for partnership forums taking place during February and March.

The messaging guide challenges myths that have held back funding of hepatitis elimination through the Global Fund, such as unfounded fears that addressing hepatitis would reduce funds for HIV or tuberculosis services. Also, the guide provides case studies of two countries which received Global Fund support for hepatitis C elimination.

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