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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.
The 'good' and 'bad' of Hepatitis C
There is ongoing optimism surrounding the evolving management for Hepatitis C. But this is also tempered by the enormity of the epidemic of Hepatitis C around the world. Whilst ~250,000 Australians living with Hep C will potentially have access to PBS subsidized highly effective directly acting antivirals in the coming months, there are still 80 million people worldwide living with hepatitis C with the vast majority in Africa (22 million) and Asia (12 million). Many of these people do not know they have Hepatitis C (i.e. they are not tested). We were also shown a sobering figure illustrating that the global burden from liver disease is increasing more rapidly than any other disease (including cardiovascular, respiratory, diabetes) and hepatitis C has now overtaken hepatitis B as the leading cause of liver-related morbidity and mortality in the world.
An example of the mortality impact of hepatitis C was starkly demonstrated in a US study. They showed that the median life expectancy was 78 years (without HCV or HIV), 60 years (with HCV) and 52 years (with HCV/HIV co-infection). And as populations in high income countries like Australia grow older, the proportion of liver transplants and liver cancer due to hepatitis C continues to rise.
Well, let me end on a good note for those living in Australia. We look forward to the first interferon and ribavirin-free single tablet regimen (Harvoni = Ledispavir + Sofosbuvir). This drug has already been given to more than 200,000 people treated outside clinical trials and is proving to be a real game-changer for the traditionally difficult to treat patients with HCV genotype 1 (>95% SVR after 8-12 weeks in treatment naive). Viekira-Pak has also been recommended by PBAC for those with genotype 1. It is also exciting to see that pan-genotypic regimens like Sofosbuvir + Daclastavir has also been approved by PBAC for genotype 3. Here's hoping that PBS listing will come in Dec 2015 or early 2016.