ASHM Report Back

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.

Managing HIV / HepC; Sofosbuvir / Velpatasvir effective with management well suited to primary care settings.

  • Font size: Larger Smaller
  • Hits: 415
  • Print

[embed=gallery]{"file":"/","place":"user:890"}[/embed]      

Doyle,J (session presentation) ; coEC Study

Lu,Y (2 poster presentations) ; ASTRAL-5 Study

This presentation by J Doyle from the Burnet Institute highlighted the findings from the first year of the co-EC study in Melbourne. Modelling presented by Scott, et al at EASL 2017, proposes that treatment of 515 co-infected individuals in Victoria will reduce the prevalence of hepatitis C within the GBM community by 80%.

b2ap3_thumbnail_IMG_20170602_115318.jpg

In the first year clinical data was collected on 160 chronic HIV/HepC co-infected individuals on ART. This included biochemical, haematological and fibrosis data. Primary care clinicians assessed this data and individuals either:

  • received immediate DAA therapy (40%)
  • received DAA therapy after specialist advice (31%)
  • were referred for specialist care (19%)

Referrals were predominantly required for known cirrhosis, APRI score >1, malignancy, renal/cardiac disease or fibroscan >12.5Kp.

This study highlighted the capacity for the majority of non-cirrhotic HIV/Hepatitis C individuals to be effectively managed by a primary care clinical team. This model of care fits comfortably with Australia's move toward patient centred, community based care within health care homes. 

ASTRAL-5 (2 poster presentations)

The efficacy, tolerability and safety of Sofosbuvir / Velpatasavir in HIV / Hep C co-infection was presented. 106 patients were enrolled for 12 weeks of SOF/VEL therapy. SVR at 12 weeks was demonstrated in the majority of patients across the 5 genotypical variants assessed. 

ASTRAL-5: SVR12 rates by genotype.

  •        Genotype                             SVR12%   (n/N)
  •        Total                                    95%
  •        GT1a                                    95%
  •        GT1b                                    92%
  •        GT2                                     100%
  •        GT3                                      92%
  •        GT4                                     100%

No patient experienced HIV virological rebound.

Side effects were similar to other available DAAs with fatigue (25%), headache (13%) and nausea (7%) reported. 

  • Drug-Drug interaction studies demonstrated no clinically significant interaction with a wide range of commonly used ART regimes. The only exception is that of EFV. There was a 53% reduction in VEL levels and thus EFV is currently not recommended for use with Velpatasvir. 

These presentations highlighted the suitability of primary care teams to effectively manage HIV/Hep C co-infection. This community based, patient centric model of care will enhance our capacity to eliminate Hepatitis C among the HIV cohort within Australia. The combination of Sofosbuvir with Velpatasvir provides pan-genotypical efficacy, good tolerability and limited drug interaction with ART. These characteristics will further enhance the ability of HIV/HepC to be safely and effectively managed in primary care settings within Australia.

Tagged in: APACC 2017
  • No comments made yet. Be the first to submit a comment

Leave your comment

Guest
Guest Thursday, 23 November 2017

RT @hepqld: Curing #hepatitis C is easy, and no longer needs a specialist to prescribe treatment. Community doctors play a pivotal role in…

ASHM ASHM