Day three Australian HIV/AIDs conference 2016
Towards elimination: parallels between HCV and HIV models of care –
Joseph Doyle, specialist in infectious diseases and public health medicine.
•Australia has 230,000 cases of HCV, a relatively low prevalence. This consists mainly of PWID but also a significant proportion who acquired HCV through sex, especially if HIV pos.
•WHO 2020 targets aim for a 30% reduction in new dx of HCV and a 10% reduction in deaths from HCV.
•To ensure success those at risk need access to frequent, regular testing to ensure early dx, with early dx leading to early connection to care. Australian guidelines recommend annual HCV testing for those at risk (or testing associated with a specific risk) and once ever testing for the rest of the population.
•Testing programs need to be considered – as antibody/PCR testing take two visits, Genotype will hopefully be made redundant and liver disease test such as fibroscan – not required for people with APRI<. Rationalising testing reduces time required to treat. Rapid RNA and annual testing in PWID - will help to meet WHO target.
•Improvements in treatment have been due to highly effective treatment available on PBS (the near future will see a single pill regardless of genotype). Community prescribing (unique to Australia and supported by specialists), no disease stage restrictions and no need for fibroscan.
•Elimination is more likely if treatment is targeted to PWID/ MSM/ Overseas born (due to a small element of vertical transmission from more high prevalence countries).
•Treatment of PWID has been shown to be effective/ safe/cost effective and can be given in conjunction with harm reduction strategies such as OST, NSP and peer support to increase the likely success of treatment and prevent reinfection.
•A scale up of treatment to 40/100 PWID p.a could halve HCV prevalence in 15 years and using injecting network data/bringing along injecting partners could reduce prevalence by 85% parallel to new dx HIV contact tracing .
•Other strategies include potential vaccines that even if only partially effective can still impact the epidemic in high prevalence area’s.
•To achieve the mortality target those with advanced disease will need to be targeted, this can also be achieved by treating PWID due to new HCV cases prevented.
•In conclusion, to meet WHO targets of HCV elimination and reduced mortality testing and treatment will need to be targeted and include injecting networks. Rationalising tests and simplified effective treatment can go someway to achieving this goal.