10 October 2018
The British HIV Association (BHIVA) is calling for accelerated efforts to cure hepatitis C virus in all those living with HIV. New treatments for hepatitis C, direct acting agents (DAAs,) have transformed the potential for cure in patients when compared to older, interferon based, therapies. Curing hepatitis C can 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 (see BHIVA guidelines bit.ly/2Ou8gGA), 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.
For further information please contact: Jo Josh, +44 (0) 7787 530 922 or firstname.lastname@example.org
Hepatitis C (HCV): is a virus that is most commonly transmitted by infected blood products, needles and syringes and less commonly through sexual intercourse, medical procedures and by being passed from mothers to their babies. Hepatitis C virus (HCV) and HIV share common routes of transmission, and so can co-infect the same individuals. When they do, they can exacerbate the clinical effects of one another. In particular liver fibrosis (scarring) associated with HCV progresses more rapidly in individuals with HIV even if they receive effective HIV treatment.
Incidence worldwide: an estimated 71 million individuals have active infection contributing to approximately 700,000 deaths a year. An estimated 2.3 million HIV positive patients worldwide are thought to have been infected with HCV, and approximately 5 per cent of those with HCV have also been infected with HIV. The WHO has published ambitious goals to make treatment accessible for 80 per cent of those who need it by 2030 with the ambition for a 65 per cent reduction in deaths from viral hepatitis by 2030.
Incidence UK: around 220,000 individuals are thought to have been infected with HCV in the UK (approximately 75 per cent in England and 20 per cent in Scotland). Over the last 5 years there has been a revolution in treatments for HCV which are now becoming more widely available. These have enabled a significant increase in those being cured of the infection. Throughout the home nations, strategies are being developed to accelerate the elimination of HCV.
1. WHO Global health sector strategy on viral hepatitis 2016-2021. Geneva June 2016
2. Stanaway et al The global burden of viral hepatitis from 1990-2013: findings from the Global Burden of Disease Study 2013 Lancet. 2016 Sep 10;388(10049):1081-1088. doi: 10.1016/S0140-6736(16)30579-7. Epub 2016 Jul
3. Platt et al Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. Lancet Infect Dis. 2016 Jul;16(7):797-808. doi: 10.1016/S1473-3099(15)00485-5
4. Cooke and Hallett HCV and HIV: shared challenges, shared solutions Lancet Infect Dis. 2016 Jul;16(7):755-756
5. Public Health England Hepatitis C in England 2018 report March 2018
6. Hepatitis C Trust Eliminating Hepatitis C in Scotland: a call to action