Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
HCV - a 25-year (r)evolution
Excellent plenary session lead by Ed Gane discussing an overview of the swift evolution of HCV over 25 years!
I've summarised the main points:
- HCV first identified in 1989 as non A non B
- 80-100 million (300,000 in Aust & NZ) and is overtaking HBV as liver mortality
- infection leads to premature death - especially co-infected HIV/HCV
- the disease burden will continue to rise as infected (ageing) patients develop complications such as cirrhosis and liver cancer.
So, how do we eliminate HCV?
- genomic diversity (both virus & host)
- funding diminished now DAAs so potent
- likely not to lead to eradicate HCV
Public Health interventions?
- eg harm reduction in PWID (syringe programs etc)
- can only do so much - decrease prevalence by 1/3 in countries which employ reduction methods ( and most countries don't)
- we need patients to be diagnosed prior to any dent being made in HCV prevalence
- currently Aust has reasonable diagnosis rates, but very poor treatment rates
- DAAs offering a new treatment paradigm for HCV by combining effective drugs with minimal SE and short durations
- e.g. Ledipasvir/Sofosbuvir (Gilead) - daily, oral, 12 week program, IFN & RBV free with excellent SVRs (97%) in GT1. Even in Pugh B/C patients, SVR nudging 90%. In the co-infected cohort the results are equally exciting
- Abbvie & Merck also have similar products
We CAN eliminate HCV with:
- better diagnosis rates
- access to fibroscan
- significant increased capacity to treat and uptake
- employ treatment as prevention
- make prescribing more accessible (in discussion in AUST)
Exciting to think that Australia looks to be leading the way!