REPORT BACK: 2ND International HIV/Viral Hepatitis Co-infection Meeting
july 27, 2015
Prepared By: Glenn Betteridge and Barbara Santosuosso, CTAC Policy Researchers
Date: July 23, 2015
On July 17th and 18th, 2015 CTAC joined attendees in Vancouver, British Columbia at the 2nd International HIV/Viral Hepatitis Co-infection Meeting. The medical and scientific research communities were well-represented, as were treatment advocates and others from the community-based and NGO sectors, including representatives from the Treatment Access Group, the Clinton Foundation, Medicins sans Frontiers, and several Canadian AIDS service organizations. The overall theme of the Meeting was, “HIV/Viral Hepatitis: Antiviral Therapy Access,” accompanied by the hastag #ACureForAll. The Meeting website has the agenda, and in the coming months the presenters’ PowerPoint slides and a meeting report will be also be posted..
Much of the Meeting content focused on treatment for and treatment access issues related to hepatitis C virus (HCV) infection and HIV/HCV co-infection. This focus reflects the location of the conference (i.e., a high-income setting where the burden of hepatitis C is greater than of hepatitis B), and the recent and still rapidly evolving revolution in medications to treat chronic hepatitis C infection. The development of new, effective, well-tolerated, yet high-priced antiviral therapy for treating HCV has many parallels with HIV combination therapy, which was announced in Vancouver at the 1996 International AIDS Conference. This new class of HCV medications is referred to as direct acting antivirals (DAAs) because they target HCV and interrupt the virus as it tries to reproduce. DAAs are often used in combination with other DAAs or with certain older medications. This evolution will no doubt sound familiar to those of you knowledgeable about HIV antiretroviral medications, combinations, treatment strategies, and treatment access issues.
In the lead-up to and throughout the Meeting, CTAC was active on Twitter, providing real-time highlights of the presentations as well as the questions and discussions. Our Twitter handle is CTAC_CAN. We are trying something new with this report-back. We have used the software program Storify to tell the “story” of the Meeting, as captured in our Tweets (and re-Tweets). Our tweets include presenter Twitter handles, links to reports and other resources, as well as pictures of key slides.
Before we get to the Storify, here are CTAC’s six “take-home” messages and related thoughts from the Meeting:
- The new DAAs have revolutionized treatment of HCV and HIV/HCV co-infection, reducing the duration of treatment and its side-effects, with greatly increased success rates. Dr. Jordan Feld of Toronto Western Hospital sounded a cautionary note on the rush to treat HIV/HCV co-infection, given the lack of data from co-infection studies, the rapid development of new and more effective DAAs, and the risks associated with treatment failure for the health and wellbeing of people living with HIV/HCV co-infection. He didn’t say “don’t treat” but highlighted the need for up-to-date information and medical expertise when treating co-infected patients for HCV infection.
- From a global public health perspective, the optimal combination for the scale up of HCV treatment is DAA therapy composed of sofosbuvir and daclatasvir. This combination has proven highly effective at treating a range of HCV strains (aka genotypes), in people at various stages of chronic HCV and liver disease, and for people who have had previous HCV treatment. In addition to medication price reductions, the scale up of HCV treatment will require generic production, and government commitment to the infrastructure necessary for HCV testing, diagnostics and treatment. Several presenters called for national hepatitis action plans, and pointed to ongoing data analysis and modeling that is being used to inform such plans. Of note, Canada does not have a national hepatitis action plan, and trails many countries (including some middle-income countries) in rates of chronic HCV treatment.
- Access to these new, revolutionary DAAs is severely limited—across high-, middle- and low-income countries. Because they are novel medications, they are protected by patent laws in many countries and are sold at costs that put them out of reach of the vast majority of people living with chronic HCV infection. Using an impactful graphic, Andrew Hall from the UK reported that gram-per-gram the HCV antiviral medication daclatisvir costs more than diamonds at current market prices in the UK. He also reported that the price of manufacturing generic versions is expected to fall drastically and quickly.
- It is possible to successfully treat HCV infection in people who use drugs. A number of presenters reported on successful programs (whether pilot studies or ongoing), all of which provide psychosocial support through multidisciplinary teams. Some presenters made the case for “treatment as prevention” among people who use drugs.
- Canadian physician-researchers are global leaders in HCV and HIV/HCV co-infection research and clinical care. Many of these physician-researchers have also been leaders in HIV research and clinical practice. CTAC asks, “Isn’t it time that physicians involved in treating HIV and viral hepatitis in Canada formed an association, to speak with one voice on important issues like access to treatment, harm reduction and drug policy, and to establish standards for treatment and care?” What do you think? We would love to hear from you.
- There are parallels between the HIV and HCV epidemics, including the challenges of public health responses (i.e., awareness and diagnostic testing, treatment scale-up, adherence and support). The growing HCV treatment access movement has drawn on the experience of the HIV movement—activists, advocates, researchers, public health practitioners and government leaders—and should continue to do so.