Hep C eradication

I'll admit it now, I haven't been very up-to-date on the global approach to Hep C treatment, but this talk really brought me up to speed on several aspects.  Thanks to Dr Joseph Doyle for the great talk.

Global elimination targets

• worldwide there are 2.2 million people living with HCV/HIV
• compares to 37 million with HIV
• odds of HCV infection were 6 times higher in people living with HIV
• most HepC infections related to IVDU but some sexual exposure
• target: 30% reduction in infections and 10% reduction in deaths (2020)

Elements needed for elimination

• testing
• early reliable diagnosis, frequent, regular testing
• diagnosis allows connection with care and treatment, education, harm minimisation services, may influence at risk behaviour
• Aust: recommends annual testing
• but may need to recommend more frequent testing if we are serious about eradication
• access to care
• recent PBS listing to many new drugs
• all are now interferon free
• community prescribing is encouraged (after discussion with ID/hepatology)
• no disease stage or drug/alcohol restrictions
• in contrast to other countries where drugs are restricted to those with cirrhosis
• this restriction would reduce costs but won't make much headway into eradication
• effective treatment
• sofosbuvir and velpatasvir (single pill regimen for all genotypes)
• others are also coming soon
• treating people at risk
• target IVDU, MSM, born overseas in HPC
• cost effective allocation
• $20k for 4 years of extra life (if severe disease)
• $60k for 6 years of extra life (if mild disease)
• therefore even cost-effective to treat mild disease
• many other options cost >$20k per year of life
• harm reduction strategies
• HCV vaccine

The medications are effective, the funding is there to support the clinicians, patients are enthusiastic and actively seeking treatment - I think this is an exciting time for Hep C management and I am optimistic to see the future.