In Memoriam: Anita York
Our beautiful friend, Anita York (May 27, 1953 – Feb. 7, 2019), was honoured Feb. 17, 2019 in a private family ceremony. HepCBC, for whom she worked for many years as a key volunteer and as a Coordinator of Volunteers, is mourning the loss of this outspoken peer advocate, always ready to battle for anyone fighting hepatitis C, or to prevent even one more person from suffering from this debilitating disease. Read more…
Finally, Maviret, AbbVie’s hepatitis C drug, has made it through Canada’s approval process and has been listed for coverage by Ontario’s PharmaCare. We hope BC PharmaCare will also list it soon.
“MAVIRET is the first and only 8-week, pan-genotypic treatment for chronic hepatitis C patients without cirrhosis and who are new to treatment (from: Decisions Resources Group. Hepatitis C virus: disease landscape & forecast 2016 and 2017)…
MAVIRET is the only pan-genotypic treatment approved for use in patients across all stages of chronic kidney disease”
Current protocols for HCV post-SVR monitoring may need updating to expand screening for liver cancer to those without cirrhosis. This article is dedicated to all non-cirrhotics who have been diagnosed with liver cancer following treatment for HCV.
HepCBC’s volunteer Webmaster, CD Mazoff, PhD (discourse analysis, McGill), is battling liver cancer (HCC). For several years, CD has faithfully published the online HepCBC Weekly Bull every Friday, showcasing Canada’s most important viral hepatitis news of the week. The last few weeks, the bulletin has not gone out because our webmaster has been diagnosed with Stage Four liver cancer (HCC), and is currently taking a palliative chemo-therapy regimen which regularly leaves him weak, nauseated, and in pain. Nevertheless, he has been trying to teach new volunteers how to do his job.
CD did not have cirrhosis, so was not subject to the post-SVR monitoring (hepatitis C after-cure) protocols recommended every 6 months for those who have cirrhosis. Such monitoring includes a liver ultrasound and blood tests for alfa-feto protein (AFP), ALT, AST, and other factors. If CD had been monitored the same as someone with cirrhosis, his HCC would likely have been caught much sooner, and he would probably have been eligible for one of the current HCC treatments which can extend patients’ lives for many years, or until they can get a transplant. CD, now age 69, had lived with hepatitis C several decades before he was cured in 2015 with the new Gilead direct-acting antiviral (DAA) Harvoni. However, liver tests had always shown he had no obvious liver scarring or fibrosis, so after he achieved SVR, he was told he was cured, that he should simply celebrate the good news, and that he needn’t worry about his liver any more. CD is not alone, as shown in the two articles referenced below which probe this issue.
We recommend the following actions to address the need for broadened post-SVR HCC monitoring:
a retrospective study be made of HCC patients who have been cured of hepatitis C, including any pre- or post-treatment assessments of liver damage (degree and date[s]), treatment (regimen[s] and beginning/end date[s]), age and gender, estimated number of years patient was infected, and progress of the HCC over time (NOTE: this study would probably be based on the BC Centre for Disease Control’s BC Hepatitis Testers Cohort database);
with the above data, a new, broader post-SVR monitoring protocol be developed which extends the HCC monitoring currently recommended for those with cirrhosis to non-cirrhotics, even to those showing no liver scarring; and
responsibility for such a broader monitoring protocol be given by HCV treaters to patients’ family practitioners/GPs/NPs once SVR has been achieved, as making requisitions for these tests could be easily (and more economically) accomplished at this level of practice.
The following articles further support the three above actions: (i.) January, 2019 article shows that 20% of hepato-cellular carcinoma (HCC) cases develop in non-cirrhotic livers, and the typically-late diagnoses mean the prognosis of these patients is poor:
“… HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population…[T]here is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients…”
[World J Hepatol. 2019 Jan 27;11(1):1-18. doi: 10.4254/wjh.v11.i1.1. Desai A1, Sandhu S2, Lai JP3, Sandhu DS4] https://www.ncbi.nlm.nih.gov/pubmed/30705715
Our beautiful friend, Anita York (May 27, 1953 – Feb. 7, 2019), will be honoured tomorrow (Feb. 17, 2019) in a small family ceremony. HepCBC, for whom she worked for many years as a key volunteer and as a Coordinator of Volunteers, is mourning the loss of this outspoken peer advocate, always ready to battle for anyone fighting hepatitis C, or to prevent even one more person from suffering from this debilitating disease. Anita was tireless, always in the trenches, and a great example of what a volunteer should be; in particular, we valued her great sense of humour and hearty laughter.
We first met Anita at a memorial for another strong Hep C peer advocate, Kelly O’Dell, in 2011. Anita and Kelly had partnered to organize World Hepatitis Day Vancouver events in 2009 and 2010. When she joined forces with HepCBC, Anita helped organize several more large, public Vancouver World Hepatitis Day (WHD) events as well. We referred to her and the other women on the WHD Committee as “The Hepatits,” in grudging acknowledgement of how the disease is so frequently mis-spelled. Over the next few years, Anita made wonderful signs to encourage the HepCBC Liver Warriors team and other participants at the Goodlife Victoria Half Marathon, even though she was unable to do such strenuous activity herself (Run like you Stole Something! Run, Awesome Stranger! The End is Near…). Anita was a real trouper, and though she felt unwell most of the time, she never complained, even when it was obvious she must have been in pain.
Anita graduated from Kitsilano High School and has a partner, Eero Taivainen, who brought her much joy particularly in her last months of life, and a beloved son, Sean York, of whom she was very proud, particularly as she raised him as a single mom.
So please Rest in Peace, you will be greatly missed, Anita – from your friends and colleagues at HepCBC.
Using Telemedicine HCV Care Model in Prisons in SPAIN
“HCV telemedicine program satisfying, cost-effective in Spanish prison: A telemedicine program brought high levels of satisfaction and proved cost effective in patients with hepatitis C in a Spanish prison, according to data presented at The Liver Meeting 2018…” Read more about Spain’s prison-based HCV “Telemedicine” treatment model.
Saturday in Surrey! Visit HepCBC booth at January 26th Surrey Health Expo
Come visit HepCBC’s “Liver Wellness” info table at the “Surrey Health Expo” on Saturday, January 26, 2019 between noon and 5 pm. It is at Surrey City Hall, 13450 – 104 Avenue in Surrey. Please stop by to say hello to our volunteers. The organizers generously donated HepCBC a 2-page spread in “South Asian Health” magazine plus the space for our booth. Come, enjoy, and support this great annual event with us.
Using Nurse-led HCV Care Model in Prisons in AUSTRALIA “Nurse-led HCV care model results in 95% or higher SVR rates in prison: A decentralized, nurse-led model of hepatitis C care with direct-acting antivirals was significantly effective and led to high levels of sustained virologic response in a large cohort of inmates, according to a recently published study.” Read more about Australia’s prison-based “Nurse-Led” and “Sexual Health Service” treatment models.
Free CME-certified WEBINARS on Fatty Liver Disease Jan. 29-31, 2019 HepCBC is quite interested in NASH [Non-alcoholic steatohepatitis] because people with hepatitis C are particularly vulnerable to NASH, even after being cured of hepatitis C! Register for a free CCO webinar January 29th, 30th, or 31st: “Identifying and Managing NASH in High-Risk Populations: A Silent Epidemic.” Targets physicians seeking CMO credits, but anyone can register.
New Study Shows Potential Benefits of Screening All New Cancer Patients for Hepatitis
Study of 3051 patients determined prevalence of chronic HBV, HCV, and HIV infection among patients with newly-diagnosed cancer. A high proportion of those detected with viral hepatitis in this screening were newly-diagnosed (42.1% of the chronic hep B and 31% of the hep C), suggesting that hepatitis B and hepatitis C screening of all those newly-diagnosed with cancer “may be warranted”, though screening them for HIV probably is not.
Come visit HepCBC’s “Liver Wellness” info table at the Surrey Health Expo on Saturday, January 26, 2019 between noon and 5 pm. It is at Surrey City Hall, 13450 – 104 Avenue in Surrey. Please stop by to say hello to our volunteers Dr. Anu Dhavan, Dr. Urvashi Beruar, and peer advocate Cheryl Reitz. View poster at: http://hepcbc.ca/wp-content/uploads/2019/01/20190126_SurreyHealthExpo.pdf