ANVISA warn against the use of contraceptive by hepatitis C infected women

The organization identified adverse effects of the interaction of HCV medicine and the pill hormone (*)

The warning is valid for all women who undergo hepatitis C treatment

The National Heath Surveillance Agency (ANVISA), published on August 17, a health warning addressed to women who takes the medicine Viekira Pak in their treatment against hepatitis C. According to the Government Agency, women who undergo HCV treatment taking this specific drug are forbidden to take oral contraceptive containing ethynil estradiol – semisynthetic hormone.

According to ANVISA, there are risks of side effects at the drugs interaction. The agency recommend the patients to see a doctor for guidance about going off the pill or switching the contraceptive method and also if they feel unusual tiredness and weakness, lack of appetite, nausea and vomiting or light-colored stools during the treatment with Viekira Pak.

According to ANVISA, the use of contraceptives containing ethynil estradiol should be discontinued two weeks prior to start Viekira Pak therapy. During the treatment, patients may use different formulation of oral contraceptive or change the medicine to a non- hormonal contraceptive method. After ending the treatment, the ethynil estradiol contraceptive treatment can be restarted two weeks after ending Viekira Pack treatment.

Since August 2016, Anvisa, in association with the Ministry of Health, has been monitored the adverse effects for the use of new drugs that were newly introduced, in June 2015, into SUS (Unified Heath System) for the treatment of hepatitis C.

(*) By Júlia Marques, O Estado de S. Paulo, August 18, 2017

Para ler a reportagem em português, acesse Anvisa faz alerta para uso de anticoncepcional por mulheres com hepatite C.

FOAESP and RNP+SP talked to PEHV-SP and decided by joint advocacy programme

Pinheiro, Caminada and Giacomini after meeting

Members of the State of São Paulo Forum on NGO/AIDS (FOAESP) and the State of São Paulo National Network of People Living with HIV/AIDS (RNP+SP) met the coordinator of the State of São Paulo Programmee on Viral Hepatitis (PEHV-SP), Sirlene Caminada last Monday, on August 14th. The meeting, requested by FOAESP and RNP+SP aimed to draw an humanitarian policy framework.

Rodrigo Pinheiro reported the FOAESP initiative on embracing not only the national and state STD/HIV/AIDS strategies as also Viral Hepatitis strategy at the parliamentary fronts, the last cause introduced through the project “A Social Demand for Hepatitis C in the State of São Paulo”, implemented by FOAESP and funded by Coalition Plus.

According to Caminada, despite of the programmes on HIV/AIDS and Viral Hepatitis being distinct, the FOAESP engagement on viral hepatitis policy advocacy is a gain, as it “adds the HIV/ AIDS advocacy expertise to the viral hepatitis cause and FOAESP advocacy policy pushes both fronts as one, encouraging them on working together”.

As a sexual transmissive infection (STI), the hepatitis B prevention comprises the  same HIV/AIDS and other STIs prevention standards, and HBV vaccine adds efforts on avoiding disease. The Ministry of Health has newly introduced HBV vaccine campaign, which covers all population, not only the risk group or priority groups, as before, helping on hepatitis B prevention.

Caminada reported that in July, extraordinary events were organized in order to celebrate Hepatitis Day and, among them, PEHV-SP worked on a week vaccination campaign, reinforcing HBV immunization programme in the counties, reminding all population inclusion. “Most part of individuals in their 20s or younger have already taken HBV vaccine in their childhood, but part of population lacks immunization.” There is a “gap” among older population which is necessary to fill.  

There are also logistic failures in some important sectors to be fixed. For example, the STD healthcare service sector, might have a vaccination room to attend individuals who look after their services, but it fails. Not only must people who look after HIV tests at the Counceling and Testing Center (CTA) undergo vaccination, but it is also necessary to make them to take the three dosages, as prescribed.

“We need to reinforce those information to the FOAESP linked organizations at our meetings”, said Rodrigo Pinheiro.

The Parallel World of Hepatitis C

“Talking about hepatitis C, it is necessary to frame a different  approach, as it represents a different reality”, Caminada suggested, remembering the HIV and Viral Hepatitis social movements never worked together.

In Rodrigo Pinheiro’s opinion, the historical distance has decreased. “The FOAESP were invited to the Southeastern Congress on Viral Hepatitis when it was reported the programme we are developing” he said.”Our proposal is both fronts work together, as partners. “

“The goal includes to widen the access to HCV treatment and cure as well as hasten the development of HCV vaccine, widen HBV vaccination and treatment campaign as well as hasten HBV cure, not found until now ”, explained the FOAESP president.

“It is not possible to affirm that hepatitis C is a STI, despite the fact of HCV Virus might be transmitted by anal intercourse and the chances of being infected increases for times on HIV- positive individuals comparing to HIV- negative individuals.  This subject needs to be discussed among groups of people living with HIV and the subject was never addressed at CTA”, Caminada explained. “Hepatitis C needs specific discussion that has never happened”, added her.

As an agreement of the parts, PEHV-SP will participate the FOAESP ordinary meetings, every month, when it will be invited the infectious disease doctors Simone Tenore and Paulo Abraão Ferreira, both members of the CRT-AIDS-SP and the State of São Paulo Federal University (UNIFESP).

The representative Reategui and Pinheiro

National Policy Advocacy

From August 15th to 17th, members of the FOAESP visited the National Chamber and met the representative Marcos Reategui (PSD-AP), volunteering the organization on acting with the Joint Parliamentary Committee on Viral Hepatitis Strategy at the House of Representatives. The representative appreciated the attitude showing enthusiasm and promised to schedule a meeting with the parliamentary front shortly.

Public Hearing for For Viral Hepatitis

The representative Conceição Sampaio (PP-AM), who proposed the public hearing to discuss the Viral Hepatitis issue in Brazil at the Chamber Committee on Constitutional, Justice and Citizenship (CSSF), demonstrated great contentment on having the subject among the pre-legislative proposals. “Hepatitis C became a heavy burden to Amazonas and Brazil, in my opinion, addressing the issue in the Chamber is very important”, she said. The public hearing was scheduled for October 31st at CSSF.

Discrimination discussed at the Congress

The representative Kokay and Pinheiro

The secretary of CSSF, Rubens Carneiro, has reported that the bill n° 7651/2014,  which turns into crime every discrimination against viral hepatitis carriers, first and foremost against hepatitis C carriers, has priority to be discussed in committee.

Yellow July Policy Advocacy

In June, the representative Erika Kokay (PT-DF) referred to the  Committee on Constitutional, Justice and Citizenship (CCJC) of the Chamber, by the rules of the House, for the "constitutionality, legality and legislative technique" of the bill n°3870/2015, establishing Yellow July in the National Calendar. As the bill committee staff,  the congresswoman has now pledged to request its inclusion in the voting list of the CCJC.

FOAESP e RNP+SP são recebidos pelo PEHV-SP e definem pauta conjunta

Pinheiro, Caminada e Giacomini após a reunião

Representantes do Fórum das ONG/Aids do Estado de São Paulo (FOAESP) e a Rede Nacional de Pessoas Vivendo com HIV/AIDS do Estado de São Paulo (RNP+SP) foram recebidos, na última segunda-feira, 14 de agosto, pela coordenadora do Programa Estadual de Hepatites Virais de São Paulo (PEHV-SP), Sirlene Caminada. A reunião foi solicitada pelo FOAESP e RNP+SP visando uma articulação mais orgânica.

Rodrigo Pinheiro informou sobre a iniciativa do FOAESP agregar à atuação nas frentes parlamentares de enfrentamento às DST/HIV/AIDS estadual e nacional também as frentes de combate às hepatites virais, por meio do Projeto Uma demanda social pelo tratamento da hepatite C no Estado de São Paulo, em execução pelo FOAESP e financiado pela Coalition Plus.

Para Caminada, o fato de os programas de combate ao HIV/aids e às hepatites serem separados não é relevante e a inserção do FOAESP no advocacy das hepatites virais nas casas parlamentares representa um ganho “porque agrega a expertise da luta contra a aids à causa das hepatites”. Segundo ela, duas frentes de atuação podem andar juntas.

Por ser uma infecção sexualmente transmissível (IST), a prevenção às IST e ao HIV/aids engloba as informações sobre a prevenção da hepatite B. Além disso, a hepatite B é prevenida com a vacina recentemente introduzida pelo Ministério da Saúde no calendário de vacinação para toda a população – e não apenas para grupos prioritários.

Caminada informou que em julho, por ocasião dos eventos alusivos ao Dia Mundial de combate às Hepatites, o PEHV-SP realizou uma semana de intensificação junto aos municípios sobre disponibilização da vacina da hepatite B para toda população. “Ha um grupo na faixa etária dos 20 anos que foi imunizado na infância, mas há um grupo etário em descoberto”. Há “sobra” nas faixas etárias mais velhas que é preciso diminuir.

Em outros grupos importantes há falhas na logística de vacinação que precisam ser eliminadas. Por exemplo, o grupo que procura o serviço de DST, que idealmente deveria ter uma sala de vacinas e não tem, que procura o teste de HIV nos centros de testagem e aconselhamento (CTA) e deve receber a oferta da vacina, que é indicada. E o esquema todo de vacinação (três doses) deve ser aplicado para a pessoa ser imunizada.

“Vamos reforçar estas informações às organizações filiadas nas reuniões do FOAESP”, afirmou Rodrigo Pinheiro.

O outro mundo da hepatite C

“Em relação à hepatite C é preciso pensar na forma de atuação, porque é outro mundo”, sugeriu Caminada, referindo-se ao afastamento histórico dos movimentos sociais de aids e de hepatites.

Segundo Pinheiro, este afastamento vem sendo superado. “O FOAESP foi convidado para o Encontro Regional Sudeste das Hepatites para mostrar o trabalho que estamos desenvolvendo”, disse ele. “A proposta é atuar conjuntamente, em parceria.”

“Queremos trabalhar o acesso ao tratamento e à cura, bem como o desenvolvimento de uma vacina para a hepatite C. Também, para a vacinação e para o tratamento e a cura – que ainda não existe – para a hepatite B”, explicou o presidente do FOAESP.

“A gente não pode dizer que a hepatite C é uma IST, porque ela não é, ainda que a transmissão do vírus C em transmissão anal para quem tem HIV é quatro vezes maior do que para quem não tem HIV. Essa é uma questão que tem de ser tratada nestes grupos de pessoas vivendo com HIV. E essa é uma discussão que não se faz no CTA”, explicou Caminada. “Não se faz uma discussão para o vírus C, que precisa de uma visibilidade específica”, acrescentou.

Como encaminhamento, foi pactuada a presença do PEHV-SP nas reuniões ordinárias mensais do FOAESP, inclusive com convites aos infectologistas Simone Tenore e Paulo Abraão Ferreira, ambos do CRT-Aids-SP e da Universidade Federal de São Paulo (UNIFESP).

O deputado Reategui e Pinheiro

Advocacy Nacional

De 15 a 17 de agosto, na Câmara dos Deputados, em Brasília, o FOAESP conversou com o deputado Marcos Reategui (PSD-AP), colocando a organização à disposição para atuar junto à Frente Parlamentar Mista de Enfrentamento às Hepatites Virais do Congresso Nacional. Entusiasmado com a iniciativa, o deputado se comprometeu a marcar uma reunião da Frente em breve.

Hepatites em audiência

A deputada Conceição Sampaio (PP-AM), que propôs à Comissão de Seguridade Social e Família (CSSF) da Câmara dos Deputados a realização de audiência pública para discutir a questão das hepatites virais no Brasil, demonstrou satisfação com tema posto numa pré-agenda na Comissão. “A hepatite C tem sido um problema sério no Amazonas e no Brasil. Eu acho importante essa discussão na Câmara”, justificou. A audiência está pré-agendada para 31 de outubro na CSSF.

Discriminação na pauta

A deputada Erika Kokay e Rodrigo Pinheiro, no Congresso

O secretário da CSSF, Rubens Carneiro, informou que o Projeto de Lei (PL) nº 7651/2014, que proíbe toda e qualquer forma de discriminação a portadores de hepatites virais, em especial a portadores do vírus da hepatite C (HCV), tem prioridade para ser pautado na comissão.

Por uma pauta

Em junho, a deputada Erika Kokay (PT-DF) apresentou parecer à Comissão de Constituição e Justiça e de Cidadania (CCJC) da Câmara dos Deputados, pela “constitucionalidade, juridicidade e técnica legislativa” do PL nº 3870/2015, que institui o Julho Amarelo. Relatora do PL na comissão, a deputada se comprometeu agora a solicitar sua inclusão na pauta de votação da CCJC.

Brazil faces the hurdle of the lack of medicine for the treatment of Hepatitis C (*)

In the last July 27th, as an act to celebrate Hepatitis Day, the minister of health, Ricardo Barros, announced the acquisition of 25.000 HCV treatments to carry out Hepatitis C Programme in Brazil, thereby fulfilling the treatment goal of 35.000 patients per year, as it was achieved in 2016.

At that moment, the Ministry of Health medicine supply was scarce and, actually, to avoid shortages, the purchases should already have started in May, at latest in June. Nevertheless, the medicines acquirement announced in July by the minister of heath was received with great relief.

Unfortunately, from that moment until now, the second fortnight of August, the contracts with the drug manufacturers have not even been signed, and, worsen the picture, the medicines to treat infected patients are over and the waiting queue to get medications is about 5.000 individuals.

Then, it is lenient to wonder whether the minister is lying or been deceived by his assistants who are liable for the management supply and purchase of medicines.

(*) Adapted from Grupo Otimismo de apoio ao Portador de Hepatite's homepage – hepatitis carrier support group.

Para ler a manifestação do Grupo Otimismo, clique no link acima. 

HCV/HIV co-infection is discussed at FOAESP ordinary meeting

The FOAESP ordinary meeting

The real viral hepatitis and AIDS co-infection threat have been discussed at the FOAESP ordinary meeting, in August, on the basis of the topics discussed at IAS Conference, in France, and the activities developed by Projeto Bem me Quer, GIV and FOAESP.]

Jorge Beloqui talked about WHO's goal for eliminate Hepatitis C by 2030. The target also seeks to reduce chronic hepatitis mortality rate by 65%.

According to Beloqui, there are about 3.800 HIC/HCV co-infected individuals under treatment in Brazil, 78% of them are undergoing treatment in São Paulo. In his opinion, the presented database emphasis how difficult remains the access to HCV treatment in Brazil.

Dr. Leda Jamal, CRT, reported the TB/HIV co-infection database in the state of São Paulo, including the social characteristics of the disease. According to the doctor, the surveillance data has found 5.664 new cases of tuberculosis in 2016, 86,4% of those individuals were submitted to HIV seropositive testing, and, among them, 536 individuals were diagnosed with TB/HIV co-infection (9,5%). Less than one-third of those people are undergoing antiretroviral treatment.

The comorbidity between alcohol and drugs abuse and co-infection was one of the main topics at the meeting, as it requires the healthcare professionals to undertake greater awareness at the reception and treatment.

Click the link to read the full article in Portuguese: http://agenciaaids.com.br/home/noticias/noticia_detalhe/26680.