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.

 

Jason Ong