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

Current epidemic

- 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? 

Vaccination?

- 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)

DAA therapy?

- 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:

- FUNDING

- 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) 

- FUNDING!!

Exciting to think that Australia looks to be leading the way!