The British HIV Association (BHIVA) is calling for accelerated efforts to cure hepatitis C virus in all those living with HIV.
New treatments to cure hepatitis C, direct acting agents (DAAs) have transformed the potential for cure in patients when compared to older, interferon based, therapies. To cure hepatitis C could not only reduce the risk of cancer and liver cirrhosis, but also reduces the risk of cardiovascular disease, diabetes and other associated conditions. Until recently, access to these expensive treatments was limited but with treatment now widely available on the NHS, the new priority is to ensure all those with the virus are diagnosed, linked to services and cured.
As part of a concerted and collective effort towards eliminating hepatitis C as a major public health threat, BHIVA will be working closely with local services over the coming year to ensure all patients co-infected with HIV and hepatitis C are linked to care and treatment. We propose the following ambitious targets:
- 80% of all patients with diagnosed HIV and hepatitis C co-infection cured of hepatitis C by April 2019 (with 100% of patients assessed for therapy)
- 90% of all patients cured of hepatitis C by April 2020
- 100% of all patients cured of hepatitis C by April 2021
In contrast to recent rapid progress in treating the majority of those diagnosed with HIV and hepatitis C co-infection, we expect the achievement of 100 per cent cure to be slower. This is because services will have to treat a small number of particularly vulnerable patients who struggle to make appointments and take medicines. In the short term, many services are likely to need additional staff and new ways of delivering care to ensure all those with the virus can be cured. Achieving this is likely to require plans tailored to individuals being delivered in different settings across the UK.
At the same time as increasing the uptake of treatment, it is important to maintain hepatitis C prevention initiatives and regular testing in those at risk, particularly given the potential of bridging networks between those most vulnerable in the HIV positive and other at-risk communities. Patients continue to be diagnosed with new HCV infection, even after cure, and in some settings there remain policies restricting treatment of these patients until chronic infection is established. These groups are particularly likely to pass on infection and such policies have the potential to undermine progress being made towards hepatitis C microelimination (elimination within a particular group of patients) within people living with HIV (PLWHIV). We would urge all health commissioners to ensure treatment continues to be available for all who need it to stop the epidemic re-emerging in PLWHIV.
BHIVA will work closely with public health agencies to monitor progress in all parts of the UK. For example, with support from Public Health England, BHIVA estimates there were approximately 3,300 people living with diagnosed HIV and hepatitis C in England at the beginning of 2016, and that over half of these patients have now been cured for hepatitis C as a result of treatment with DAAs. In some regions (for example, the North East of England and Tayside in Scotland) 100 per cent cure is already close to being achieved.
The UK can be the first country to achieve microelimination of hepatitis C in those living with HIV, well ahead of WHO targets. We should seize this opportunity.
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