Hepatitis C New Zealand blog January 2010 New Zealand Viral Hepatitis Whakatane 2010
New Zealand Viral Hepatitis 3rd NZ Conference Whakatane 2010
Friday 05 March – Saturday 06 March 2010
War Memorial Complex, Whakatane, New Zealand
Invited Speakers: Professor Mitchell Shiffman, USA
Professor Andrew Lloyd, Australia
Dr Morris Sherman, Canada
Dr James Fung, Hong Kong
Around half the conference will be about hepatitis B and the other half hepatitis C
With topics such as
Relevance of viral load; is it a predictor to HCC? James Fung
Multidisciplinary approach of HCC in NZ John McCall or Adam Bartlet
Therapies available for patients with HCC in NZ Catherine Stedman
State of the Art Lecture
Optimisation of Outcomes with current standard-of-care” (on use of baseline and
on-treatment responses (RVR, EVR) to individualiase therapy, weight-based RBV).
What’s next – direct acting antivirals (DAAs )Mitch Shiffman
HCV in Correctional Facilities
HCV prevention, treatment and follow-up in prison populations Andrew Lloyd
HCV in NZ correctional facilities Frank Weilert
NZ model in an Auckland prison Steve Gerred
Difficult-to-treat patients
State of Art Lecture
“Approaches to non-responders – retreatment, induction dosing IFN,
higher dosing RBV, maintenance therapy – do they work” Mitch Shiffman
Alternative therapies for HCV
Is there alternative therapies for HCV treatment and do they work? TBA; College of natural therapies
Middlemore audit of patients taking alternative therapy Jacinda Ryan
Hepatotoxic therapies Sarah Fitt
Debate: Should there be a national register for chronic HBV & HCV?
You can find out more about the conference at the hepatitis foundation of New Zealand Website here
Our invite must have got lost in the mail and our budget of zero precludes travel. The joys of the peer based NGO.
New Zealand hep c news letter
Got my first email copy of the New Zealand hep c news letter , a joint effort by the Auckland Christchurch and Dunedin Hepatitis C Resources centres.
Well actually I accidentally deleted it so if you want to check it out Hepatitis C resource centre 0800 224372 (0800 22 HEPC)
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.
I mentioned this chemist based anonymous testing for hepatitis at English pharmacies a while back; the results of the trial have been interesting
19 pharmacies in 5 PCT areas offered free, on-demand hepatitis B and C dried blood spot tests to clients who had been at risk of contracting viral hepatitis as part of a 3-month pilot project organised by The Hepatitis C Trust. 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.
Dev Dalvar from D R Pharmacy in Sandwell PCT commented on the pilot: “Offering hepatitis B and C tests in my pharmacy has been a huge benefit to the local community. The people diagnosed will now be able to access potentially life-saving treatment and many customers are more aware about the viruses and risk factors.
Charles Gore, Chief Executive of The Hepatitis C Trust said: “It is a tragedy that increasing numbers of people with hepatitis C are dying, often because they have been living with the hepatitis B or C undiagnosed for years, even decades. There are at least 100,000 people living with the hepatitis C unawares but only 8,000 people were diagnosed last year. We desperately need a new approach to testing that will find the undiagnosed patients and this pilot study shows pharmacy testing could be just what is needed.
A series of Hepatitis C videos from the Harm reduction works
HIV, hepatitis C and injecting drug use, part 2: The sharing of injecting equipment
“often with additional commentary” for Sara and Sue
The Minister of Health finally released a copy of a stock take of hepatitis C services in New Zealand. My copy is the appendix of the new Hepatitis Plan to be released by the Ministry soon.
It covers a lot of the detail of Hepatitis C Treatment around New Zealand, it really is a lottery of care with some regions winners and others losers in the level of treatment available.
1. What are your guidelines for referral to secondary care for patients with hepatitis C?
2. Do you add any information to seek prioritisation?
3. What is on the referral form? Is there routinely provided an adequate history including recent LFTs, risk factors for HCV exposure, duration of infection, alcohol intake, how
long clean from IDU, etc?
4. Where are the referrals sent from primary care (Central Bookings Office, specific departments or individuals)? Who is responsible for sorting these? Who proritise referrals?
5. Which speciality units in your hospital will provide outpatient assessment and treatment for patients with hepatitis C: General Medicine, Infectious Diseases, Hepatology, Gastroenterology?
6. How are hepatitis C patients prioritised relative to other patients within the specialty and what are the factors used to prioritise hepatitis C patients (eg, acute hepatitis C,
probably cirrhosis, hepatoma, immunosuppressed, etc)?
7. What is the GP’s role in the process after referral?
8. How many referrals are returned to the GP due to low priority? What determines such “Iow priority” status?
9. Are patient referrals confirmed prior to the clinic day — by letter, phone?
10. What is the non-attendance (DNA) rate and what is the process following a DNA? How many times will DNA patients be rebooked? If DNA patients are discharged, are
they referred back to their GPs?
11. lf patients are not suitable candidates for treatment, refuse treatment or have undergone treatment but failed, are they discharged back to the GP?
12. Who conducts the initial new-patient assessment- specialist, registrar, house-surgeon or nurse? ls every clinic supervised by a specialist?
13. What tests are ordered at this initial assessment: LFTs, HCV-RNA, viral load, viralgenotype, ultrasound, liver biopsy?
14. How is the severity of liver disease assessed in people with bleeding disorders prior to treatment- biopsy (transjugular vs percutaneous), ultrasound, scintography, other?
15. What is done to prepare patients for antiviral therapy: What various activities happen between new-patient specialist assessment and commencing treatment:
16. ls a psychiatric assessment performed routinely on all patients prior to the decision on therapy? How is this done — subjective assessment? Objective score (eg, HADS
score)? Formal liaison psychiatry review?
17. Do patients receive information in preparation for treatment (re side effects, etc)? If so,what information and in what form? For example, clinic visits, written information, etc.
18. What testing do you do after first assessment? ie, genotype? viral load? biopsy?
19. What are the exclusion criteria for treatment: alcohol abuse/length of abstinence; injecting drug use; length of abstinence; methadone; cannabis; other?
20. ls there a standard treatment protocol for hepatitis C that you follow?
21. In patients infected with HCV genotype 1 do you follow the “earIy stopping rule” for treatment, ie, if HCV-RNA level after 12 weeks has not dropped by more than two logs
from baseline level, is treatment stopped?
22. ln patients infected with HCV genotype 2 or 3, how many weeks treatment is administered?
23. What is the total number of first time specialist appointments for patients with hepatitis C at your hospital annually?
24a. How many patients with diagnosed hepatitis C were referred to your unit in 2005/2006?
24b. How many patients with diagnosed hepatitis C were referred to your unit in 2004/2005?
25. What is the total number of patients [with hepatitis C] treated at your hospital annually?
26. How many patients are CURRENTLY on treatment for hepatitis C at your hospital?
27. What is the total number of follow ups, including nurse and physician appointments seen at your hospital annually?
28. How many patients with chronic hepatitis C were seen at your hospital between 1 January and 31 December 2006? Between 1 January and 31 December 2005?
29. lf someone with hepatitis C is referred this week from their GP, what is the approximate waiting time for an initial specialist assessment at your hospital?
30. What was the total number of patients with hepatitis C waiting for initial assessment as at 1 July 2006?
31. How many new hepatitis C patients were added to the waiting list in the last six month period?
32. What is the approximate time interval between receipt of initial referral from GP, to first time specialist appointment, to commencement of antiviral therapy?-
33. What are the factors that contribute to waiting times?
Looking forward to the answers to these regional health inequalities in the Hepatitis Plan to be released soon
Happy Birthday to the needle exchange in New Zealand 21 years old this year
Approximately 200 outlets around New Zealand provide new needles to injecting drug users and safely dispose of used needles. Around 3 million clean needles are distributed each year with many outlets also providing information and advice about preventing the transmission of blood-borne diseases and drug treatment options.
Speaking at an event on Tuesday to mark the 21st birthday of needle exchanges in this country, Mr Henderson said that, thanks to the programme, New Zealand has a lower HIV rate amongst its intravenous drug users than any other country, and that the spread of hepatitis B amongst injecting users has largely been contained.
“We’ve got the prevalence of HIV/AIDS down to just 0.3% and studies indicate there have been no new AIDS or hepatitis B infections within this group in recent years. This is quite remarkable considering blood-borne diseases are often rife amongst drug-using communities where needle-sharing is commonplace.
“It’s wonderful news for New Zealand as a whole because carriers of blood-borne diseases interact with others in their communities and can spread these diseases to people who don’t inject drugs.
“Over the last 21 years, the Needle Exchange Programme has saved thousands of Kiwi lives and millions of tax-payer dollars.”
You notice Charles (NENZ ) dos not mention Hepatitis C, The needle exchange is not effective in stopping the spread of Hepatitis C, It is slowing the spread of Hepatitis C, But how, can it work better to stop the growth and spread of Hepatitis C ?
The latest Household Drug Survey indicates 2 percent of New Zealand ers inject or have injected drugs, including opiates and methamphetamine, in the last 12 months. This means 85,000 people are potentially susceptible to blood-borne diseases from drug use.
Estimating New Zealand Hepatitis C Figures By District Health Board Areas
We had a go at calculating the estimated numbers infected by HCV by district health board areas I used a conservative estimate of .8% of population being infected, here is what I calculated using 2007 figures.
DHB populations are approximately:
Estimate of 0.8% population HCV
Number with HCV
DHB
Population (000s)
Northland
154
1232
Waitemata
516
4128
Auckland
439
3512
Counties Manukau
468
3744
Waikato
355
2840
Bay of Plenty
204
1632
Lakes
102
816
Tairawhiti
45
360
Taranaki
107
856
Hawke’s Bay
153
1224
MidCentral
165
1320
Whanganui
63
504
Hutt
141
1128
Capital & Coast
282
2256
Wairarapa
39
312
Nelson Marlborough
135
1080
West Coast
32
256
Canterbury
491
3928
South Canterbury
55
440
Otago
185
1480
Southland
110
880
Source: Statistics NZ population projections, Sep 2007.
4241
33928
I just wanted to get a idea of the scale of the problem I used similar figures to the Hepatitis C infection in New Zealand: Estimating the current and future prevalence and impact July 2000.
Looking forward to seeing the new Hepatitis C Plan in the next few weeks the Hepatitis C Plan will hopefully address the problem areas from the Stock take report
Topper Headon (Clash)
Topper talks about his year on treatment and how he beat the hepatitis C virus
clean and healthy post hepatitis C treatment , a great short video
Hepatitis C New Zealand Pharmac widens access to Interferon
March 9 2009
Good news from PHARMAC, who manage New Zealand Government expenditure on pharmaceuticals.
Access widened to pegylated interferon for hepatitis B and hepatitis C genotypes 2 and 3
A widening of existing subsidised access to include patients with chronic hepatitis C, genotype
2 and 3 who do not have cirrhosis.
Provision of subsidies for patients with chronic hepatitis B, where patients are treatment Naïve;
ROCHE products Pegasys and Pegasys RBV Combination Pack will be the sole supply brand of pegylated Interferon and pegylated interferon and ribavirin combination packs until 31 December 2012.
Delisting of Schering Plough product Pegatron, from the Pharmaceutical Schedule.
There will no longer Schering Plough, Pegatron products available cutting out one treatment option that has been used in the past for people who have been unresponsive to Roche products?
Pharmac site has more details and prices for pegylated interferon in New Zealand
Christchurch Community Hepatitis C Clinic
I missed this news when it came out but a notable moment in community health was the opening of Christchurch Community Hepatitis C Clinic, New Zealand’s first free community hepatitis C clinic
Nurse and hepatitis C specialist Jenny Bourke will run the clinic. Bourke urged anyone who thought they might have hepatitis C to go to the “discreet” Manchester St clinic for a check. “We want to get people checked out as soon as possible so they don’t get things like cirrhosis of the liver or other liver damage,” she said.
TO contact Christchurch Community Hepatitis C Clinic contact Christchurch Hepatitis C Resource Centre 0800 224372 (0800 22 HEPC)
Indonesia 12 million with Hepatitis C
The Jakarta Post | Mon, 03/16/2009 11:25 AM | National
Indonesians are becoming increasingly more vulnerable to cancer of the liver, with more than 40,000 new cases detected each year, health experts warn.
“Around 42,600 new cases of liver cancer occur every year in the country,” health expert Terawan Agus Putranto said Saturday during a seminar on cancer diagnosis and therapy in Jakarta.
“Most of the cases stem from hepatitis, which is a prevalent disease among Indonesians,” added the radiology specialist from Gading Pluit Hospital in North Jakarta.
He said careless use of needles and unmonitored blood transfusions had contributed significantly to the spread of hepatitis, which is transferable through blood, faeces and sexual contact. Indonesia has Hans U. Baer, an expert on cancer-related abdominal surgery, told the forum that hepatitis was a disconcerting issue in Indonesia, with around 10 percent of the country’s 240 million people exposed to the Hepatitis A virus, 5 percent to the Hepatitis B virus, and another 5 percent Hepatitis C.
No plans to start drinking coffee again for me but a reason perhaps to not stop drinking coffee if you have hepatitis C
With 90 percent accuracy, three clusters of proteins in the blood samples were found to predict who would respond to therapy and who would not.
The treatment pathway is along and challenging journey through a varied mind scape for some it is not successful and others it works and they achieve a svr Sustained Virological Response.
Proteomics is the large-scale study of proteins, particularly their structures and functions.[1][2] Proteins are vital parts of living organisms, as they are the main components of the physiological metabolic pathways of cells. The term “proteomics” was coined to make an analogy with genomics, the study of the genes. The word “proteome” is a blend of “protein” and “genome“.
And you may ask what does Proteomics have to do with Hepatitis C ?
Researchers from the Duke University Clinical Research Institute found a similarity among those with Hepatitis C who are among the 50 percent who do not respond to interferon-ribavirin combination therapy. Presented October 31, 2008 at the annual meeting of the American Association for the Study of Liver Disease, the Duke researchers used proteomics to identify specific proteins that foretold the likelihood of Hepatitis C treatment success.
With 90 percent accuracy, three clusters of proteins in the blood samples were found to predict who would respond to therapy and who would not.
Some one emailed www.hcv.org.nz a interesting question that all people with hepatitis C face disclosure
” Hello,
What are the legal requirements, if any, you must do to inform a partner or employer
that you have hepatitis C.
”
It thought I would ask my too favorite Hepatitis C professionals their expert opinions
and here is what they said, which deserves a wider audience
***note these are not legal opinions for that you need to ask a lawyer***
The Hepatitis C Educator reply
As far as I’m aware, as HCV is not a notifiable infection, there are no legal
requirements to disclose anyone’s HCV status to a future or current employer. In other
words you can’t loose your job just ’cause you have Hep C. If an employer fires staff for
being HCV+, then they are in big trouble. It’s called unfair dismissal. Also, an employer
cannot force an employee to reveal their HCV status.
Now, as far as the partner situation goes, if the relationship is a healthy and loving
one then personally I would tell my partner. Once again, there’s no legal requirement to
do so. But a moral one, I would like to think so. If you like, pass my mobile number
and/or the HCRCO email and phone number on, and inform that I’m free to talk about any of
this kind of stuff.
0800 224372 (0800 22 HEPC) To contact your nearest hepatitis C resource center (New Zealand only)
The hep c nurse
Hi
From my understanding there are no legal requirements to inform.
To be in a relationship and wishing to continue in a relationship I
would have thought you would want to inform your partner…….it
doesn’t lead to a good relationship to deny someone that information.
It can become very nasty when they suddenly find out (this is from
experience)
The person infected with Hepatitis C needs to have a good understanding
about the spread of the disease; to risk spread and infecting their
dearly beloved. ie no sex toys, use condoms during menstruation or when
there is any genital lesions, keep cuts and wounds covered, keeping
razors for personal use only etc etc
Hope this helps
…………………………
On a personal level I don’t tell everyone I meet, I am aware stigma and discrimination exist and keep my Hepatitis C status on the down low.
I tell my partner and family and close friends I tell it’s selective, everyone is different. I practice tactical disclosure.
Magdalena has some great information in her thesis on how different peers deal with the issue.