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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 - Treatment As Prevention
An interesting first day with varied sessions. It was great to hear about a number of very positive treatment approaches using the newer drug options for HCV, the direct acting antivirals. The afternoon session "Ending HCV in Populations" included Professor Greg Dore on HCV treatment as prevention in prisons and Professor Margaret Hellard on treatment and prevention to eliminate HCV in people who inject drugs.
Prof Dore indicated that of the 30,775 Australian prison population there is 30% HCV prevalence but with HCV antibody prevalence in prisoners varying across the states e.g. 52% in QLD, 26% in NSW, 25% in VIC. In prisons there is 60% prevalence of injecting drug use, with 10-15% annual transmission of HCV yet currently no preventative vaccines available, no needle and syringe programs and limited harm reduction methods available. With the new treatment options there is a much greater scope for targeting treatment of larger numbers of prisoners, with the SToP-C study addressing this.
Margaret Hellard highlighted a shift in focus of who to target in treatment of HCV and expectations re the impact it produces. With 8,000 to 10,000 new HCV infections annually and PWID key drivers of HCV transmission, she stressed that you don't need to treat everybody with HCV to get a reduction in prevalence. If 40 out of 1,000 PWID are treated it can have a significant impact - it would reduce HCV prevalence by 50% over 15 years.
With the new and future HCV treatment regimes having fewer side effects, high effectiveness, allowing improved dosing schedules and shorter treatment duration it will allow different models of treatment. From work by the Burnet Institute it has been found that social networks of PWID substantially impact transmission rates. A "treat your friends" strategy - treating certain individuals of the network they inject with - could lead to reductions in risk of HCV reinfection post-treatment, and reduce HCV transmission through the network. The TAP study will assess community based treatment of PWID and their injecting networks, looking at rates of HCV primary infection and reinfection.
The take home message from these talks is that with direct acting antivirals for HCV there are now new opportunities to scale up treatments and look at different approaches to treating populations in need.