A new development for hepatitis C treatment is the availability of a genetic test which predicts  treatment success the Il28B test now used in New Zealand and can help clinicians and patients make informed decisions on how to best manage their HCV infection.

Researchers found the gene by scanning the human genome to look for differences between people who responded well and those who did not respond to hepatitis C treatment.

Because people inherit one copy of a gene from each parent, and may get either the high-risk or the protective variation, they can end up with one of three different genotypes: two copies of the high-risk variant, two copies of the protective variant or one of each.

The Il28B test results are expressed as allele combinations, C/C, C/T, or TT

The IL28B genotype test can be used to predict response to peg-IFN and RBV in HCV genotype 1 patients. The test result indicates whether the patient has an IL28B CC, CT, or TT genotype. Patients who have the IL28B CC genotype are more likely to have a SVR with peg-IFN and RBV treatment, whereas patients who have the TT genotype are more likely to be non responders. This information can help clinicians and patients make informed decisions on how to best manage their HCV infection.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024597/

Among treatment naive Genotype 1-infected subjects of European ancestry who were enrolled in the IDEAL study, approximately 69% of those who carried 2 C alleles (C/C) at rs12979860 achieved an SVR compared with 33% of those with the C/T genotype and 27% with genotype T/T.^[7]

http://www.medscape.com/viewarticle/740029

Direct-acting antiviral agents (DAAs)  and The IL28B genotype test

The availability of IL28B genotype testing to help predict SVR coincides with another major advance in the treatment of chronic hepatitis C, the introduction of direct-acting antiviral agents (DAAs) that specifically target enzymes critical to HCV replication

data suggest that carriers of the less favourable IL28B genotypes will be less likely to respond to triple therapy that includes protease inhibitors and raise the possibility that IL28B genotype-based models may be useful for predicting the likelihood of SVR in response to treatment with peginterferon + ribavirin + protease inhibitors.

http://www.medscape.com/viewarticle/740029

Strikingly, Dr Rauch said, all the teams found an association between favourable treatment response and single nucleotide polymorphisms (SNPs) in the IL28 gene near the “B” subunit that encodes interferon lambda-3. This finding was “very consistent” among four studies published over the past six months, all looking at HIV-negative individuals.

Each research group identified several relevant SNPs, but one – known as rs8099917 or the “risk allele” – was common to all of them; another, rs12980275, was identified in three studies.

Across the studies, the high-risk genotype was approximately half as common amongst people who achieved sustained virological response to interferon-based therapy than amongst non-responders. It was even rarer amongst people who spontaneously cleared HCV without treatment.

http://www.aidsmap.com/IL28B-gene-variation-predicts-response-to-hepatitis-C-treatment-will-it-change-treatment-of-co-infection/page/1437991/

Thoughtful incorporation of IL28B genotyping into treatment decision-making may serve to increase the number of patients for whom treatment is successful while minimizing those in whom it is deleterious.

http://hepatitiscnewdrugs.blogspot.co.nz/2011/04/hepatitis-c-il28b-genotype-testing-now.html

best of health

www.hcv.org.nz

Deportation threat for hepatitis caught from prostitutes

Mr Veng, a postgraduate accountancy student, had been given the medical clearance for a student visa in 2006 but his application for a further visa in 2009 was declined after the department found him to have an unacceptable standard of health.

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10738304

Rotorua mayor supporting World Hepatitis Day

Know it, confront it’ is the theme for World Hepatitis Day 2011 and Mayor Kevin Winters is getting behind the initiative by declaring Thursday 28 July World Hepatitis Day in Rotorua.

http://www.voxy.co.nz/health/rotorua-mayor-supporting-world-hepatitis-day/5/95727

Hepatitis: The Silent Killer

Monday, 25 July 2011, 2:24 pm
Press Release: Hepatitis Foundation

“We need to dramatically increase the number of New Zealanders who receive antiviral treatment for their disease to mitigate this health and financial burden.

http://www.scoop.co.nz/stories/GE1107/S00115/hepatitis-the-silent-killer.htm

Many with Hep C not diagnosed or treated

Nelson health practitioners say a large chunk of people may not have been diagnosed with or treated for the “silent epidemic” of hepatitis C.

http://www.stuff.co.nz/nelson-mail/news/5336062/Many-with-Hep-C-not-diagnosed-or-treated

Wairarapa wars on hepatitis

Needle exchange manager Brendon Olsen said hepatitis B and C was common among intravenous drug users but the exchange had helped lower infections.

“[Hepatitis B + C] is prevalent but it has dropped.

http://www.times-age.co.nz/news/wairarapa-wars-on-hepatitis/1063989/

Hepatitis war can be won – expert

Hepatitis can be “obliterated in a generation” if intravenous drug users stick to clean needles and hepatitis B vaccinations reach almost 100 per cent of the population, a MidCentral Health gastroenterologist says.

“The tragic thing is it could in fact be eradicated quite quickly,” Dr Andrew Herbert said.

Hepatitis can be “obliterated in a generation” if intravenous drug users stick to clean needles and hepatitis B vaccinations reach almost 100 per cent of the population, a MidCentral Health gastroenterologist says.

“The tragic thing is it could in fact be eradicated quite quickly,” Dr Andrew Herbert said.

Hepatitis can be “obliterated in a generation” if intravenous drug users stick to clean needles and hepatitis B vaccinations reach almost 100 per cent of the population, a MidCentral Health gastroenterologist says.

“The tragic thing is it could in fact be eradicated quite quickly,” Dr Andrew Herbert said.

http://www.stuff.co.nz/manawatu-standard/news/5352845/Hepatitis-war-can-be-won-expert

HEP C TV advert from Christchurch

Watch out for hepatitis C when its raining blood

http://youtu.be/ognSdeTF97M

Hepatitis Foundation of New Zealand Parliamentary Breakfast

World Hepatitis Day; Hon Tariana Turia, Associate Minister of Health

Spreading the message that you can protect yourself against hepatitis B by getting immunised. Being prepared to share strategies around preventing hepatitis by taking precautions – practising safe sex, using sterile injecting equipment – and not sharing razors, toothbrushes or drug-taking equipment.

And if there’s anything to get us going – it’s the knowledge that in New Zealand, less than a quarter of those infected with hepatitis C know they have it.

All of us here today, have a clear mission to change the status of this disease from being a silent killer to a condition that can be treated and managed. It can be as simple as one, two, three.

http://www.voxy.co.nz/health/speech-world-hepatitis-day-turia/5/97728

Outpatients clinic in jail treats hep C prisoners

Four prisoners are currently being treated for hepatitis C through the outpatients clinic the Whanganui District Health Board established at Whanganui Prison in February.

They are among 15 Wanganui people being treated for the disease by the outpatients department.

http://www.wanganuichronicle.co.nz/news/outpatients-clinic-in-jail-treats-prisoners-with-h/1105721/

best of health www.hcv.org.nz

However I /we have run out of resources and energy to carry on, its been a draining experience.  Thanks to all the peers that have contributed you made it all seem worthwhile.

The www.hcv.org.nz  website will close on World Hepatitis Day 28 July 2011.

Best of health  to all with hepatitis C .

Incivek (telaprevir) , Victrelis (boceprevir) New Heaptitis C Drugs offer hope

Two new drugs approved for Hepatitis C during May. Both claim higher success rates at clearing the hepatitis C virus than existing standard treatment drugs pegylated interferon and ribavirin.

Although not available in New Zealand yet both have been trialled here on New Zealanders who have benefitted from there increased cure rates.

These new drugs are very pricey and the next challenge will be to make sure those who need them most will get access.

These new drugs will result in a combination of three drugs being taken for hepatitis C treatment “Triple therapy”

Incivek (telaprevir)

Incivek, a pill also known as telaprevir, is poised to help transform treatment of hepatitis C by nearly doubling the chances of curing the serious liver disease compared with current standard treatments

Vertex set a wholesale price of $49,200 for a 12-week regimen of Incivek, which works in combination with current standard drugs pegylated interferon and ribavirin.

http://www.reuters.com/article/2011/05/23/us-vertex-idUSTRE74M3I320110523

Information on Incivek from www.hcvadvocate.org

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Incivek.pdf

Victrelis (boceprevir)

The U.S. Food and Drug Administration approved Victrelis (boceprevir) to treat certain adults with chronic hepatitis C.

“Victrelis is an important new advance for patients with hepatitis C,” said Edward Cox, M.D., M.P.H, director, Office of Antimicrobial Products in FDA’s Center for Drug Evaluation and Research. “This new medication provides an effective treatment for a serious disease, and offers a greater chance of cure for some patients’ hepatitis C infection compared to currently available therapy.”

Victrelis is a pill taken three times a day with food. The therapy is part of a class of drugs referred to as protease inhibitors, which work by binding to the virus and preventing it from multiplying.

The most commonly reported side effects in patients receiving Victrelis in combination with pegylated interferon and ribavirin include fatigue, low red blood cell count (anemia), nausea, headache and taste distortion (dysgeusia).

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm255390.htm?utm_source=twitterfeed&utm_medium=twitter

Victrelis will cost $1,100 per week, which means patients and insurers will pay between $26,000 and $48,000 for Victrelis, depending on the length of treatment. This price doesn’t include the cost of interferon and Ribavirin

http://www.thestreet.com/story/11119619/1/merck-strikes-first-in-hep-c-drug-battle.html

Information sheet on Victrelis from www.hcvadvocate.org/

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Victrelis.pdf

The new Christchurch Hep C Mag

The new Christchurch Hep C Mag Christchurch Online here

http://hepcnz.org/newsletter.html

Hepatitis C screening strategy based on age, rather than risk factors

I always get annoyed at how hepatitis C is labelled the drug users disease. This artificial stigma deters some people from seeking treatment. Which is why this strategy seems much more effective and logical

“A screening strategy based on age, rather than risk factors, could have a significant impact”

this makes more sense to find undiagnosed hep c instead of asking people about risk factors that may have been decades ago

http://www.internalmedicinenews.com/news/infectious-diseases/single-article/age-based-hep-c-screening-may-work-better-than-risk-based-screening/0d0cee8463.html

Hepatitis C Auckland treatment numbers

In a previous blog post comparing treatment patterns we noticed Auckland had declined from 88 in 2007 to 45 in 2010.

http://hcv.org.nz/wordpress/?p=275

Although these figures are accurate they don’t take in to account patients treated on Hepatitis C drug trials apparently Auckland patients have been taking the option of drug trails and the actual Auckland figures inclusive of patients on drug trails may actually show an increase in numbers treated.

Ten currently recruiting drug trials for hepatitis c drugs in new Zealand this month with a range of protease inhibitors and some other novel therapies included.

Click here for current hepatitis C drug trials in New Zealand

Staying Safe

New Zealander Dr Magdalena Harris has been working on a new study in London Staying Safe is a HCV prevention project which aims to learn from the experts – people who have been injecting for the long term and have not
been exposed to HCV.

By interviewing people who have avoided Hepatitis C while still using intravenous drugs

What relevance has this got for HCV prevention and harm reduction interventions in general? Well, what has been a major finding of the Staying Safe study to date is that the safe injecting practices and other protective factors that helped people to avoid HCV were not necessarily motivated by BBV avoidance, but by more pragmatic concerns such as avoiding track marks (for those early in their injecting careers – particularly the Sydney participants), maintaining venous access (primarily London participants) and facilitating a pleasurable injecting experience.

http://injectingadvice.com/articles/guestwrite/241-magdalena1

The saga of the Melbourne clinic hepatitis C Infections continues with

A DOCTOR charged with allegedly infecting 49 women with hepatitis C has been freed on $200,000 bail.

Anaesthetist James Latham Peters, 61, of Hawthorn appeared at the Melbourne Magistrates Court this afternoon, where he faced 162 charges.

Those charges include 54 counts of conduct endangering life, 54 counts of recklessly causing injury and 54 counts of negligence causing serious injury.

http://www.heraldsun.com.au/news/more-news/doctor-held-over-hep-c-infections/story-fn7x8me2-1226063969044

Best of Health

www.hcv.org.nz

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Christchurch Hepatitis C resource Centre post quake

Quake destroyed premises, but Centre rises again thanks to dedicated staff like Fleur who now operates Christchurch Hepatitis C resource centre out or her home until they find temporary premises

Fleur here (Office Admin/Education Coordinator) We have only just set up the
work computer here at my home until we find temporary premises.

So emails will now get through. Our work phone number has been diverted to
my home number also -so from 9-4pm there will be someone to answer the call.
The (0800 224 372) helpline number is being answered by Otago Hepatitis
Resource Centre until we get our premises sorted.

Contact details for
Hepatitis C Resource Centre Christchurch

Phone 03 366 3608, Fax 03 366 0649
0800 224372 (0800 22 HEPC)
hcv@xtra.co.nz

New Fibro scan machine for Christchurch

Some good news for Christchurch, with a new fibro scan machine being installed in the city. These machines remove the need for a liver biopsy. Scanning the liver with sound waves.

They are very cost effective at around $200 for a fibro scan versus the more expensive approx $1200 for a liver biopsy, we hope more DHB’s will invest in fibro scan machines

Liver biopsy has been a significant deterrent to undergoing treatment for Hepatitis C the introduction of fibro scan machines is a great step forward for patients

At present there are machines in Auckland Waikato and now Christchurch.

Contract to develop services for Improvements in Hepatitis C Services

Hepatitis Foundation Recently awarded a national Ministry of Health contract to develop services for Improvements in Hepatitis C Services. I recent meeting with them left me feeling positive about the future of Hepatitis C in New Zealand and we will watch with interest the progress on developing improved services for those living with Hepatitis C.

Hepatitis Foundation mission statement

To promote positive health outcomes to the people of New Zealand through education and research into viral hepatitis, and early detection and long-term follow-up of chronic hepatitis B and C.

The aims of the new Hepatitis C project

Establishing the current status of Hepatitis C (HCV) service delivery and will include assessing the differing status, issues, service delivery models and needs for individuals with HCV within DHBs and regions. The findings will contribute to strategies and / or recommendations for the implementation of key interventions.

Shared Care Tool. Shared care between primary care and specialist services for these groups of patients will manage and, if possible, avert any downstream complications.

Fibro scanning. Equitable access to fibro scanning technology will allow all patients with HCV to have access to this technology in order to assess the stage of liver damage. Assessment of liver damage is usually required before patient treatment plans are commenced.

The development of education / information resources for specific sub-population ‘risk’ groups. These resources will support better detection and treatment of infected individuals from these groups.

Research and provide an implementation plan for a potential three-year programme to promote the targeted testing of specific ‘at risk’ groups to improve early HCV diagnosis rates and treatment options for these individuals. Development of a plan for targeted testing will enable implementation of more effective detection and treatment of at-risk groups.

Undertake research and development of innovative HCV service delivery model(s) for New Zealand. Time-limited pilot projects with appropriate evaluation will improve future access to and quality of HCV treatment services.

An assessment of the current status of HCV Service delivery in New Zealand. Establishing the current status of Hepatitis C (HCV) service delivery will act as a primary tool for the accurate assessment and design of new interventions, and will include: assessing the differing status, issues, service delivery models and needs for individuals with HCV within DHBs and regions. The findings will contribute to strategies and / or recommendations for the implementation of key interventions.

Hepatitis Foundation Hepatitis C Project Team

Kelly Barclay (Hepatitis C Project Manager)

Phone: 021 636 931

Email: kelly@hepfoundation.org.nz

Helen Payne (Hepatitis C project coordinator)

Phone: 021 621 416

Email: helen@hepfoundation.org.nz

The Ministry has launched an e-learning tool for Hepatitis C for  general practitioners and nurses.

http://learnonline.health.nz/course/view.php?id=41

Some general information for Hepatitis C patients

http://learnonline.health.nz/file.php/41/Resources/Hep%20C%20Resources%20-%20Patient%20Information.pdf

Auckland resource Centre

Auckland resource Centre has undergone another regime change and emerged stronger check out their latest publication full of informative goodness about Hepatitis C here, One of the best newsletter to come out of NZ that I have seen look forward to more for the new team who you can read all about inside.

Auckland Hepatits C Liverlinks magazine

New hepatitis C  inhibitor drugs to market in Europe and USA

Perhaps the biggest new this month is the progress of the new hepatitis C inhibitor drugs to market in Europe and USA.

An FDA advisory panel will review both Merck’s boceprevir and Vertex’s telaprevir on successive days next month. (April 2011) I expect both will get positive recommendations from the committees considering the unmet need, high efficacy — cure rates in the 70% range — and reasonable safety record.

The drugs haven’t been tested head-to-head against each other, but based on their individual trials, Vertex and marketing partner Johnson & Johnson (NYSE: JNJ ) seem to have the upper hand.

While both drugs work better than current treatments and are even able to cure patients that failed previous treatments, they still require PegIntron or Pegasys to be taken alongside the oral medications. The treatment time can be shortened from 48 weeks down to 24 weeks, but that still means patients are injecting themselves and dealing with nasty side effects for six months.

http://www.fool.com/investing/high-grow … at-up.aspx

Expensive new hepatitis c Drugs

They are going to be expensive but bring a dramatic improvement in treatment outcomes.

New hepatitis C drugs from Merck & Co. and Johnson & Johnson (JNJ) are being sold in France for 22,000 euros ($31,271) and more, a precedent some doctors say may limit access after the medicines are approved throughout Europe.

J&J and Vertex Pharmaceuticals Inc. (VRTX)’s telaprevir costs 22,000 euros under a French program for seriously ill patients for whom there is no other effective treatment on the market, according to patient association SOS Hepatites. Merck & Co. said its boceprevir costs 30,000 euros under the same program.

The price may drop once the drugs are approved for the broader market, Merck and J&J executives said. Still, the French model shows the new drugs may triple the cost of hepatitis C treatment, leaving England, Russia and eastern Europe likely to delay use or restrict which patients are allowed access, said Antonio Craxi, director of gastroenterology and internal medicine at the University of Palermo.

“It may be that we can’t use it at all until the price comes down,” Mark Thursz, professor of hepatology at Imperial College London, said in an interview at a conference in Berlin over the weekend. “It’s not the best economic environment to launch an expensive new drug.”

The U.K.’s National Institute for Health and Clinical Excellence may restrict the new drugs to patients who have tried existing treatments without success, Thursz said. The agency may also require genetic tests to determine whether patients are likely to respond to the medicines, he said at the meeting of the European Association for the Study of the Liver.

Best of Health

www.hcv.org.nz

Here are the comparison figures for Hepatitis C patient treatment numbers in New Zealand 2007 2010.

Patients treated for Hepatitis C in New Zealand
	2010	2007
Auckland	45	88
Bay of plenty	44	10
Canterbury	93	73
Capital and coast	43	35
Counties Manuka	38	17
Hawkes Bay	11	12
Hutt Valley	20	15
Lakes	19	13
mid central	28	8
Nelson / Marlborough	26	11
Northland	29	15
Otago	47	17
South Canterbury	7
Southland	15	7
Tairawhiti	2
Taranaki	25	3
Waikato	35	24
Wairarapa	3	0
Waitemata	55	35
West Coast	16	11
Whanganui	16	14
	616	408

* The 2007 figures come from New Zealand Ministry of Health Stock take of Existing Services May 2007 May 2008

* The Christchurch (2007) figures come from a official information request to Canterbury DHB

* The 2010 figures come from a reply to a official information act  request from Hon Tony Ryall NZ Minister of Health Feb 2010

(note the 2010 figures received were for 11 months I have added a estimated monthly figure for December 2010 to bring figures up to a year for comparison purposes).

Numbers treated for Hepatitis C in New Zealand overall increased during the period 2007 – 2010

Numbers treated for Hepatitis C in New Zealand overall increased from 408 in 2007 to 616 in 2010.

One reason for the increase may be the 2009  Pharmac funding of treatment for genotype 2 & 3 patients who according to Prof Ed Gane make up 40 to 45 per cent of NZ hep c patients. Previously these patients were not eligible for funded treatment and were under treated in some DHB regions, such as Otago.

There is a noticeable increase in numbers treated in some regions.

And a decline in some regions such as Auckland.

If you’re a hepatitis C patient access to treatment has improved especially if you have genotype 2 or 3 , or live in one of the regions with substantial  improvement in treatment numbers,  such as Taranaki  from 3 patients in 2007 to 23 in 2010

best of health

www.hcv.org.nz

This blog dedicated to memory of Bethli Wainwright

Bethli an Auckland woman whose liver transplant prompted her to set up a website for other liver patients has died.

Bethli Wainwright, 44, died in Auckland Hospital on Christmas Day 2010

Wainwright created a website for liver patients as she waited for her own liver transplant several years ago.

She said then she wanted to provide the information she was looking for as she waited for a transplant.

She also wanted the opportunity to make her donor family proud of the decision they had made “in giving me the gift of life”.

Wainwright also researched issues surrounding liver transplants, including her research paper entitled “Liver transplantation as a catalyst for change”. It covered the social and economic wellbeing outcomes for New Zealand patients who were given a new liver between 1998 and 2005.

http://tvnz.co.nz/health-news/battler-l … es-3989744

http://www.livers.org.nz/

New Zealand Ministry of health still confused about counting Hepatitis C numbers

I was reading the Hepatitis C information page on New Zealand Ministry of heath web site.
http://www.moh.govt.nz/moh.nsf/indexmh/hepatitis-q&a
“How many people have hepatitis C ?

Worldwide about 200 million people have been infected with hepatitis C. More than 33,000 of them are New Zealanders. There are thought to be at least 25 new infections in New Zealand each week.”
Ministry of Health fantasy land : 25 new infections a week according to ministry of health?

Reality : But what does the ministry of health’s own public health surveillance actually say about the actual rate of infection ?
20 cases for the whole year  November 2009 – 2010

The Institute of Environmental Science and Research Ltd (ESR) is under contract with the Ministry of Health (MoH) contributes to the national public health surveillance effort. Including Hepatitis C
http://www.surv.esr.cri.nz/
http://surv.esr.cri.nz/PDF_surveillance/MthSurvRpt/2010/201011NovDHBRolling.pdf

So New Zealand Ministry of health claim 1300 new case of hepatitis c per year but can only account for 20 new cases of hepatitis C per year.

Gee wonder which figure the NZ ministry of health use for planning? 20 the actual number of diagnosed new hepatitis C cases per year or the or the  fantasy figure of 1300 new infections per year ?

The ministry needs to get real about accurately measuring hepatitis C. There is a huge gap between 1300 new cases per year and the 20 recorded cases.

In Australia there has been a recent push to establish needle exchanges in prisons

Fight looms on jail needle plan

BY BIANCA HALL
05 Jan, 2011 01:00 AM
The ACT Government is on a collision course with territory jail staff after indicating the nation’s first prison needle-exchange program could be introduced at the Alexander Maconochie Centre.

ACT Health Minister Katy Gallagher said yesterday that a new draft report of an 18-month audit of drug use in the AMC made a strong health case for a needle and syringe program within prison walls.

ACT Health figures show more than half of male inmates tested in June were hepatitis C positive. About two-thirds of women tested screened positive for the virus’s antibodies.
http://www.canberratimes.com.au/news/local/news/general/fight-looms-on-jail-needle-plan/2039520.aspx

Injecting hope into our prisons

ASSOCIATE PROFESSOR LYNNE MAGOR-BLATCH

A 2010 study found 33.6per cent of NSW male prisoners continued to inject while in prison, and at 90per cent, the rate of needle sharing was far higher than within the general community. This makes prisons incubators of disease.

Switzerland was the first country to provide a prison-based NSP in 1992. Since then, programs have been established in more than 50 prisons in 12 countries. This doesn’t mean that authorities have become lax on drug supply reduction.

In fact, results of these programs have not found an increase in injecting or other drug use.

They have, however, found decreased rates of blood-borne viruses, reduced needle sharing and even a decrease in needle stick injuries.

There is no evidence that a controlled NSP within the prison would threaten correctional staff safety. Rather, there is evidence that safety will be increased with a significant reduction in risky behaviours and a safer prisoner return on release to families and the community.

In April 2010, the Australian Health Ministers Advisory Council released three related hepatitis C and HIV strategies. In relation to prison-based NSPs, all three noted the appropriateness for governments ”to identify opportunities for trialling the intervention in Australian custodial settings”.
http://www.canberratimes.com.au/news/opinion/editorial/general/injecting-hope-into-our-prisons/2041494.aspx?storypage=0

Experts bolster calls for jail needle exchange

Anex chief executive John Ryan says until authorities can eliminate drugs from prisons, they have a duty of care to minimise the spread of blood-borne diseases.

“The international evidence and the evidence from around Australia is prisons are high risk environments, for particularly hepatitis C transmissions, we can’t rule out an outbreak of HIV transmission,” he said.

“People are injecting often after at least five others have used the needle, so we’re talking about extremely hazardous injecting practices.”

Mr Ryan says such a program would save the community a lot of money.

“For every dollar invested, you get four saved in the health budget. If you look at other issues, like loss of productivity, for every dollar invested you get a $27 return,” he said.

“The savings are massive and obviously we need to be making those sorts of savings in the prison system.”
http://www.abc.net.au/news/stories/2011/01/14/3112618.htm

Will be interesting to see if needle exchanges are ever established in prisons in NZ ?

Looks like Teleprivar in likely to be approved for use mid 2011

Shasun Chem to launch ‘Hepatitis C’ in June-July 2012

The supply of the Hepatitis C drug to Vertex by Shasun Chemicals is set to take off earlier than anticipated. The product is set to launch in June-July next year. “Commercial supplies have already started and we are preparing for the launch this year,” says Vimal Kumar, Managing Director of Shasun Chemicals, in an exclusive interview with CNBC-TV18′s

Q: The markets expecting that your supplies of Hepatitis C to Vertex will begin very soon. By when can you assure your investors that those supplies will kick off?

A: I cannot give details. But yes, one of the products is in Phase III, the regulatory approvals are expected to be in place by April-May and the launch to set to happen somewhere in June-July next year. Commercial supplies have already started and this year, we are preparing for the launch.

Q: Can you give us a sense of how much things could get preponed, considering the developments that have already occurred?

A: Commercial supplies have already started. Our UK subsidiary Shasun Pharma Solutions should do a topline of about 39 million pounds which is up from 32 million pound. Overall sales would grow by almost 25% over in the UK.

Q: Just with specific reference to the deal with Vertex, the estimates are that the revenues could stand to generate USD 50 to 60 million and that could actually go all the way up to USD 1 billion plus. Is that your target as well?
http://www.moneycontrol.com/news/business/shasun-chem-to-launch-hepatitis-cjune-july-2012_510464.html

Top 10 Hepatitis C News Stories of 2010 according to m Alan Franciscus from http://www.hcvadvocate.org
http://www.hcvadvocate.org/presentations/Top%20Ten%202010.htm

Best of Health for 2011-01-19
www.hcv.org.nz

“In a way it was stink, but it saved me.”

The Blenheim man received a donated liver in July 2007 after being diagnosed with hepatitis C a year earlier. The gratitude he feels to the woman whose liver saved his life has been a powerful incentive to make the most of every day and look after his body.

Through the donor co-ordinator, he has written to the donor’s family telling them he is really well and thanking them for the gift of new life.

Mr Maxwell  was 17 when he contracted hepatitis C by sharing needles – a stupid mistake of youth that came close to killing him 30 years later.

The disease was discovered in 2006 after a crash while racing downhill on his pushbike. X-rays picked up not only two cracked vertebrae but also an abnormal liver.

“In a way it was stink, but it saved me.”
http://www.stuff.co.nz/marlborough-express/features/focus/4328870/The-gift-of-life

More news from Melbourne clinic hepatitis C Infections

SHATTERED victims have told how their lives have been ruined by a rogue, drug-addicted anaesthetist who is accused of infecting them with hepatitis C
http://www.heraldsun.com.au/news/victoria/how-hep-c-doctor-ruined-his-victims-lives/story-e6frf7kx-1225945890664

First charges Melbourne Hepatitis C Infections

Detectives have charged the director of nursing at Croydon Day Surgery with attempting to pervert the course of justice.
The Age has been told that Carol Richards would have been present at many of the proceedures undergone by women who were infected with the virus. She also had responsibility for many of the procedures used at the day surgery.
http://www.theage.com.au/victoria/hepatitis-c-outbreak-woman–charged-20101125-18835.html

re brand Hepatitis C ” the anesthetist disease”

Funny thing someone said to me how unique this Melbourne case was I laughed

AP Features, May 15th, 2007
A Spanish anesthesiologist with hepatitis C was sentenced to prison Tuesday for infecting 275 people with the virus by injecting them with morphine from the same needles he used to feed his own addiction.

http://www.bookrags.com/news/morphine-addicted-spanish-moc/

More information on Protease Inhibitors

Vertex Files for Hep C Drug Approval

The timing of the telaprevir approval filing to the U.S. Food and Drug Administration was widely expected. Vertex asked FDA for priority review, which if granted, would mean an approval decision could be made by June 2011.
Telaprevir, if approved, will shorten treatment and improve cure rates for patients infected with the Hep C virus. For Hep C patients new to treatment, telaprevir combined with the current standard treatment of long-acting interferon and ribavirin achieved cure rates of 75% in a phase III study, compared to about 40% of patients treated with the standard treatment alone.

More than half of these patients were able to achieve a cure in six months, or about half the time of currently used treatment regimens.

In the other major phase III study enrolling Hep C patients who failed to respond to prior treatment, telaprevir also induced significantly higher cure rates compared to standard therapy.
http://www.thestreet.com/story/10929835/1/vertex-files-for-hep-c-drug-approval.html?cm_ven=GOOGLEN

I like to see positive news about long term health post treatment good news I guess.

Hepatitis C Treatment improves health long term

Achieving sustained virologic response after treatment for hepatitis C is a boon to patients even 20 years down the road, researchers said here.

In a cohort of patients who started treatment at the National Institutes of Health in 1984, none who achieved sustained response developed hepatocellular carcinoma, and all had improved measures of liver function in the long run, reported Chester Koh, MD, of the National Institute for Diabetes and Digestive and Kidney Diseases, and colleagues.
http://www.medpagetoday.com/MeetingCoverage/AASLD/23132

The surgeon knows best

I was a talking to a local surgeon the other day, She was very articulate on  blood transfusions,  She would not give them unless absolutely necessary ,  We now know about hepatitis C and other BBV but  there may be other risks to the blood supply we don’t know about and test for yet so its still risky,  I try to avoid giving blood transfusions to my patients .

Best of health
www.hcv.org.nz

Hepatitis C is one of the most lucrative new markets for drugs in the world.

Motivated by the huge profits Drug companies are pouring resources in to discovering the next big treatment

For Hepatitis C, the standard has been  a combination of interferon and ribavirin.

In simple terms, ribavirin is an antiviral medication that stops the virus that causes hepatitis C from spreading. Interferon prevents viral replication in surrounding cells.

Now a score of companies are racing to bring new treatments on stream. Out front are Merck (NYSE:MRK – News) with boceprevir, and a partnership of Vertex Pharmaceuticals (NMS:VRTX) and Johnson & Johnson (NYSE:JNJ – News) with telaprevir.

Both drugs are protease inhibitors, which prevent a virus from replicating itself. While they treat the same disease, they are different in both results and side effects.

Used on patients who have had no previous treatment, boceprevir and telaprevir beat down the hepatitis C virus to undetectable levels in 66% and 75% of patients respectively

By most counts, the global market for hepatitis C products is now $4 billion a year. According to a report from the commercial analysis firm Research & Markets, that should rise to $8.5 billion by 2016.

http://finance.yahoo.com/news/The-Race- … l?x=0&.v=1

These new drugs are taken with existing drugs in a combination of three drugs sometimes known as triple therapy

Details of Open hepatitis C drug trials in New Zealand

Some of these drug trials for drugs like telaprevir have been and are being conducted in New Zealand.
http://clinicaltrials.gov/ct2/results?term=hepatitis+c+New+zealand&recr=Open

Although the drugs are expected to get FDA approval next year in America (the most lucrative and largest market for these drugs) they may take several years more to reach New Zealand and be approved / funded by Pharmac.

They will add another pharmaceutical cost to treatment

If you have Hepatitis C genotype one it does improve your odds of successful treatment and maybe a shorter term of treatment.

Come out of the warehouse now ?

BURLINGTON, Mass., Sept. 27 /PRNewswire/ — Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that the launch of novel therapies for the treatment of Hepatitis C Virus (HCV), including Vertex/Johnson & Johnson/Mitsubishi Tanabe’s telaprevir and Merck’s boceprevir, will precipitate several changes in HCV treatment. According to Patient Flow in Hepatitis C Virus, surveyed physicians plan to initiate treatment in at least half of their “warehoused” HCV1 patients one year after novel therapies become available. Patient “warehousing” is a term that has been coined to characterize the phenomenon of HCV patients opting out of treatment with current standard of care in anticipation of new therapies; psychiatric events, adverse events and liver health are top reasons keeping patients away from current therapies.

The report also finds that time from initial diagnosis to treatment initiation will decrease once novel HCV therapies are available. On average, surveyed physicians stated they wait 17 months to initiate treatment in HCV1 treatment-naive patients; this time will decrease to 7 months once novel treatment options are available.

“The arrival of telaprevir and boceprevir will alter more than the drug-treatment rate and treatment initiation timing in HCV,” said Alexandra Makarova, M.D., Ph.D. “Physicians indicate they would increase the capacity of their HCV practice to accommodate the additional patients expected once novel therapies are available.”

http://www.prnewswire.com/news-releases/launch-of-novel-agents-for-the-treatment-of-hepatitis-c-virus-will-precipitate-treatment-of-at-least-half-of-warehoused-patients-103849343.html

Drug survey  RECENT TRENDS IN ILLEGAL DRUG USE IN NEW ZEALAND, 2006-2009

Findings from the 2006, 2007, 2008 and 2009 Illicit Drug Monitoring System
(IDMS)

Scary reading with the growing methamphetamine use, As people inject  methamphetamine much more frequently injecting themselves forty or fifty time a day to maintain the high  amphetamine psychosis, irrational impulsive behaviour a bad combination for transmission of hepatitis C and other BBV. Many of these new methamphetamine idu people will be new to using intravenous drugs and naive in their safety precautions.

http://www.shore.ac.nz/projects/Final%202009%20IDMS%20report.pdf

Surveillance of HIV and Hepatitis C Prevalence among Attendees of Needle Exchanges throughout New Zealand Chantal Lauzon

Well an interesting read with lots of detail a thesis submitted for the degree of Masters of Public Health at the University of Otago, Dunedin, New Zealand  another resource for those interested in Hepatitis C and needle exchanges.

“Results
In total, data from 480 respondents were included in the analysis. The majority of
respondents were male (67.3%), of European ethnicity (79.4%) and aged between
35 and 49 years. Average duration of injecting drugs was 17 years. Overall, the
seroprevalence of HIV in this population has remained very low (<1%) and there
has been a significant decline (17.6%) in the seroprevalence of HCV between 2004
and 2009 (p<0.0001). Prevalence of HCV-antibody was associated with older age,
longer duration of injecting, and a history of imprisonment, methadone treatment
and tattooing. There has been a significant increase (20%; p<0.001) in the reported
use of new needles and syringes for every injection.
Conclusions
The decline in HCV seroprevalence in injecting drug users cannot be attributed to
any particular differences in demographic characteristics of survey participants or
to trends in risk behaviours associated with risk of HCV transmission. The
national introduction of the free one-for-one needle and syringe exchange
programme in 2004 has had a large impact on growth in distribution at needle
exchanges. This reduction in economic barriers to safe injection and subsequent
increased access to sterile needles and syringes appears to have had a positive
impact on injecting practice and is possibly a factor behind the decline in HCV
seroprevalence among New Zealand IDUs who use the needle exchange
programme. The 2009 Needle Exchange Blood Borne Virus Serosurvey
contributes to the evidence base supporting the effectiveness of needle exchange
programmes in reducing injecting risk and limiting the spread of HIV and HCV
among IDUs. “

http://ourarchive.otago.ac.nz/bitstream/handle/10523/388/LauzonHCVSeroprevalenceInNZIDUs.pdf?sequence=1

The importance of narrative video

The english Hepatitis C Trust need new case studies to raise awareness in the press. We are always writing new reports, releasing new statistics and …

Well that’s it

Best of Health

www.hcv.org.nz

http://www.facebook.com/pages/Hepatitis-C-New-Zealand/99254558387

Ultrasound replaces painful liver biopsy surgery for hepatitis C patents in Auckland and Waikato

Painful biopsies have been replaced by an ultrasound technique the Fibroscan (a $200,000 machine) which provides a painless, non-invasive alternative to a needle biopsy by measuring the liver with ultrasound waves and evaluating progression of the disease.

“Obtaining liver tissue by a needle biopsy can be a very painful procedure resulting in bleeding, perforation of other organs, even hospital admission and, rarely, death,” Dr Weilert said.

“This has previously been the only option to assess the liver but the Fibroscan allows us to measure liver stiffness without invasive action.

“It will also allow us to map progress of liver disease better.”

The Fibroscan works through a probe held against the patients’ abdomen.

“The Fibroscan generates a pulse which sends waves through the liver, measuring its stiffness. The degree of stiffness in the liver indicates the amount of disease in the liver – so the greater the stiffness, the more disease there is”, adds Professor Gane.

“Because the Fibroscan procedure is so quick and easy we are able to see more patients in a shorter amount of time and patients no longer need to wait for months to start their antiviral therapy

The procedure takes about 15 minutes. There are currently machines in Auckland and Waikato

See below for Deliverable Three Undertake an analysis and develop a report on the utilisation of fibro scanning in New Zealand:

http://www.waikatodhb.govt.nz/news/pageid/2145843080

http://www.stuff.co.nz/waikato-times/news/1402330

Associate Professor Ed Gane Champion for HCV for the Ministry of Health.

Associate Professor Gane this year was appointed as Champion for HCV for the Ministry of Health.

In September 2005 a commitment was made by the government, to resolve the longstanding concerns of those infected with hepatitis C through the blood supply. Within this commitment a variety of measures were promised, including provision of an enhanced treatment package. Additional funding was sought and secured for this treatment package and a Hepatitis C Treatment Advisory group, comprising of clinicians, DHB managers and community representatives and chaired by Ed Gane was established to advise the Ministry of Health.

The terms of reference of the Hepatitis C Treatment Advisory Group were to develop a costed and prioritised Implementation Plan, supported by district health boards (DHBs) and the Ministry of Health. This group first met on 17 April 2007. During 2008, they conducted a comprehensive Stocktake of current HCV treatment services provided at each of the 21 DHBs. Following analysis of these results and other information, the committee identified barriers to accessing this treatment and geographical gaps in service provision. They identified priority interventions to improve services and patient outcomes throughout NZ and developed a costed and prioritised implementation plan for improving the access to and uptake of Hepatitis C treatment in New Zealand. The subsequent Health Report and the Hepatitis C Plan was submitted to Hon. Tony Ryall by HCTAG in January 2009.

On 28 July 2009, the Minister approved the “Strategic Directions for Hepatitis C – improving access to and uptake of hepatitis C treatment services” and signed off the funding allocation to address the key action areas within the document. These four key action areas, identified within Strategic Directions for Hepatitis C, are: (i) improving HCV treatment services;(ii) improving knowledge of HCV among primary health care providers; (iii) increasing the percentage of all people with HCV who have had the disease diagnosed; (iv) improving the knowledge of HCV prevalence in the New Zealand population and within subgroups.

Plans for primary care, including the new e-learning tool for GPs and Practice Nurses, designed to improve knowledge and encourage opportunistic screening for HCV.

Four Million Dollars Missing from New Zealand Hepatitis C Program

“A major component of the $30 million package announced in December last year is an additional $5 million per year to be invested to improve access to, and uptake of, hepatitis C treatment services. An advisory group has been established to assist the Ministry of Health and District Health boards improve hepatitis C treatment services to all people with hepatitis C, who are entitled to publicly funded health services.”
The ministry have now budgeted one million dollars for these service improvements wonder where the other four million promised went ?

So thirty million to pay for the New Zealand Ministry of health’s professionally incompetent advice and poor performance in protecting the blood supply.

Just one million of a promised five million to improve the situation and actually treat people

Four million dollars just disappearing I get the feeling this is another colossal ministry cost cutting mistake in the making how expensive is this poor health policy going to be in the long term ? time will tell.

Note : To get our (www.hcv.org.nz) copy of the Strategic Directions document we had to write many  Official Information act requests. The Ministry of Health who subsequently lied about our requests to the ombudsman (and were stupid enough to get caught lying) had withheld it for over a year. Now where do you think the Ministry tell people to go to get a copy of the “Strategic Directions for Hepatitis C – improving access to and uptake of hepatitis C treatment services”  Well here to  peer based organisation that has no funding www.hcv.org.nz we are hosting Strategic Directions for Hepatitis C document and the only place it’s available, their key document for a million dollar tender W.T.F.

What the ministry want to buy for one million dollars to improve access to and uptake of hepatitis C treatment services

The Ministry is seeking a Provider to deliver the following services for individuals with Hepatitis C:

• appropriate referral from primary care to secondary care via use of a standardised tool;
• provision of integrated care for those diagnosed but untreated or discharged following treatment via use of a shared care clinical tool / protocol;
• equitable access to fibro scanning for diagnosis;
• improved information resources for specific ‘at risk’ population groups; and
• improved detection, access and treatment service delivery models.

The following services are being purchased:

Deliverable One
Develop, consult and disseminate nationally into primary care a standardised referral tool / form from primary to specialist care.
Deliverable Two
Develop, consult and disseminate nationally across providers, a shared care clinical tool / protocol, for the provision of integrated care / management for:
Deliverable Three
Undertake an analysis and develop a report on the utilisation of fibro scanning in New Zealand including:
Deliverable Four
Develop, consult and disseminate nationally education / information resources for specific sub-population ‘risk’ groups including:

Development of a plan for targeted testing will enable implementation of more effective detection and treatment of at risk groups.
Deliverable Five
Research and provide a feasibility report for a potential three-year programme to promote
the targeted testing of specific ‘at risk’ groups to improve early HCV diagnosis rates and
treatment options for these individuals.
Deliverable Six
Undertake research and development of innovative HCV service delivery model(s) for New Zealand:

(If you want a copy of full tender document you have to go to NZ government GETS site and register )

So if you want a slice of the pie get your applications in It looks like a bunch of stakeholders have tried to carve up the funding pie in to neat little segments only time will tell how effective this will be.

Epidemiological ongoing measurement of the spread of Hepatitis C actually gets a special mention in Strategic directions document but seems to have been completely ignored in the proposal for services. I just wonder where the evidence base for this spending is coming from if we don’t accurately count the epidemic on a ongoing basis?

I would like to have seen money spent on measuring the epidemic more accurately, although as there seems to be an emphasis on meshing the diagnosis / treatment and care of hepatitis C in to a new national GP information system, may be this will also count the spread of the epidemic ?

Looks like we are going to get more community clinics (Deliverable Six) because we need to duplicate treatment services, New Zealand being awash in spare health funding we can afford this ? Most of the country has no access to support services. Wellington Waikato and Invercargill no resources no support services with rural NZ getting the big nothing.This inequality of access to support needs to be addressed on a national basis rather a than a few regions.

We are farming the newly infected from ineffective  needle exchange programs that grow the epidemic , on to community clinics at needle exchanges delivering treatment, a win win situation for needle exchanges as far as capturing  health resources.

This development of a duplicate service to serve the needs of IDU (intravenous drug users) would be better addressed by educating health professionals on how to best to care for and not stigmatize IDU using existing resources  rather than developing a expensive  duplication of resources.

Well the next six months should reveal the shape of hepatitis C improvements so I guess that is progress and I should be a bit more positive about it. Fingers crossed something good happens.

Stop people dying needlessly

My favourite way of testing and diagnosing the majority of individuals who are no longer if ever active drug users would be the English system of pharmacy testing which has proved much more successful that GP based testing.
Last year a viral hepatitis testing pilot project in 19 pharmacies across the country has found a hepatitis B or C positive patient in every 6 tests conducted. Across the pharmacies a total of 234 tests were conducted, diagnosing 35 people with hepatitis C (15% of tests) and 4 people with hepatitis B (2% of tests). This is a far higher proportion of hepatitis C positive diagnoses than found in GP surgeries, where 4% of tests find positive hepatitis C patients and 2% of tests find hepatitis B patients.

Charles Gore, Chief Executive of The Hepatitis C Trust said: “It is a tragedy that increasing numbers of people with hepatitis B and C are dying, often from particularly unpleasant liver cancer which these viruses can cause. It is a tragedy because they have generally been living with the virus for years and could have been given treatment at any point, if only they had been diagnosed. So we desperately need new approaches to testing that will find the undiagnosed patients and this pilot study shows pharmacy testing could be just what is needed.”

“If the pharmacy testing pilot is taken as a model and rolled out by PCTs and pharmacies nationally, we can stop people dying needlessly.”

The Isle of Wight continues to offer these tests after the end of the pilot scheme and has extended it to include added HIV and syphilis tests from the same sample as the viral hepatitis screen. When asked, Gary Warner from Regent Pharmacy on the Island said:

“The results speak for themselves – pharmacies see a different cohort of people to those who see their GP and therefore we can access and diagnose people who otherwise would not have been tested. As an example, the patient that was screened as HIV positive was not someone who would have accessed the test in any other way.”

http://www.medicalnewstoday.com/articles/198364.php

press video here

http://www.youtube.com/watch?v=iG49NTOvOEU

best of health

www.hcv.org.nz