Year: 2017
Type: article
Abstract: Hepatitis C virus (HCV) therapeutic development, with highly curative well tolerated all oral direct-acting antiviral (DAA) regimens, is one of the major advances in clinical medicine in recent decades.Australian Government subsidisation of DAA regimens through the Pharmaceutical Benefits Scheme (PBS) since March 2016, and the broad eligibility for access (all adults with chronic HCV infection, no prescriber restrictions other than prescriber to specialist consultation for inexperienced prescribers), provides the foundation for rapid DAA scale-up, major individual and population-level impacts, and elimination of HCV as a public health threat over the next decade.Over the period March-December 2016 an estimated 32,400 people initiated DAA therapy, representing 14% of the estimated 230,000 people living with chronic HCV infection.Importantly, in the context of the WHO elimination target of 65% reduction in liver-related mortality by 2030, an estimated 70% of people living with HCV-related cirrhosis have received DAA therapy (including through pre-PBS listing compassionate access programs).Preliminary evidence also suggests relatively high DAA uptake (comparable or higher than the broader HCV population) among people who currently inject drugs (PWID).Key trends during 2016 in relation to DAA therapy initiation included younger age distribution and higher proportions of prescribing by general practitioners, reflecting the expansion of HCV treatment access beyond large specialist centres.A range of models of HCV care are being developed and implemented, including higher throughput tertiary care (enabled by more simplified treatment monitoring and limited toxicity-based care), nurse-led care (both in community and prison settings), drug and alcohol service-based care, and primary and community health clinic care.The addition of new DAA regimens during 2017-2018, in particular sofosbuvir/velpatasvir and glecaprevir/pibrentasvir with pangenotypic efficacy, and short treatment duration (8-12 weeks), will further enhance broadened access and support diverse models of care.DAA treatment assessment and monitoring is likely to be further simplified, with qualitative HCV RNA detection potentially replacing HCV viral load and genotype evaluation, and the predictable virological responses and minimal toxicity leading to removal of on-treatment monitoring.Despite the potential broad DAA access in Australia, early evidence indicates declining DAA initiations in 2017 compared to 2016.Further efforts are required to continue high DAA uptake, particularly for marginalised populations including current PWID and prisoners.Community awareness campaigns could facilitate enhanced HCV screening and DAA uptake for former PWID and those from other risk groups (e.g.immigrant populations from high HCV prevalence settings).
Source: Journal of Virus Eradication
Author: Gregory J. Dore
Institutions: UNSW Sydney, Kirby Institute
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,950
OpenAlex ID: W3041778282