HIV update - 16th December 2015

New hepatitis C treatment works well for people with HIV

Another new treatment for hepatitis C has been shown to work as well for people who have HIV and hepatitis co-infection as it does for people who only have hepatitis C. The treatment is a pill which combines two drugs, grazoprevir and elbasvir, and is taken once a day for twelve weeks.

Older hepatitis C treatments, involving interferon injections, do not always work as well and may cause unpleasant side-effects in people living with HIV. But the newer generation of tablets for hepatitis C have excellent results in people also living with HIV.

In this study, 93% of people had a sustained virological response (undetectable hepatitis C RNA) twelve weeks after finishing treatment. The treatment was safe and well-tolerated.

Results were as good regardless of sex, age, ethnicity, hepatitis C genotype (1a, 1b or 4), hepatitis C viral load, or whether they had liver cirrhosis (late stage hepatitis C that causes scarring of the liver).

But will people who need this treatment be able to use it? That will depend on how much the pharmaceutical company decides to charge for it and on the National Health Service’s decision about which patients to prioritise for access to it. In the UK and many other countries, very few patients – mostly those who already have liver cirrhosis – are treated with the new improved hepatitis C drugs.

Prices for grazoprevir and elbasvir have not yet been set. But prices for other hepatitis C drugs such as sofosbuvir (Sovaldi) can be as high as $84,000 per person in the United States, just for a twelve-week course. The official price for the NHS in the UK is $53,000 or £35,000.

A recent investigation by the US Senate found that Gilead, sofosbuvir’s manufacturer, set this price in order to achieve the greatest share of the market, for the highest price and for the longest period of time. They were not simply recovering the costs of research and development.

And the cost isn’t determined by the price of raw materials. A researcher who has been tracking shipments of active pharmaceutical ingredients said that the cost of the chemicals needed to make sofosbuvir has dropped by three-quarters during 2015. He thinks a twelve-week course of the drug could be manufactured for less than $200.

If Merck, the manufacturer of grazoprevir and elbasvir, sets a lower price it could put pressure on Gilead, the manufacturer of the $84,000 sofosbuvir. But until something like that happens, prices are likely to remain high in the UK and other rich countries.

“It only takes one company to be brave and say ‘we aren’t going to charge £30,000, we’re going to charge £10,000’, and they will make a lot of money,” Dr Andrew Hill of Liverpool University said.

Resistance to PrEP drugs doesn’t last

One concern often raised about using HIV drugs for prevention as pre-exposure prophylaxis (PrEP) is about resistance. In other words, if people become HIV positive despite using PrEP, might their HIV already be resistant to some anti-HIV drugs, making them ineffective?

Despite these concerns, hardly any cases of resistance have been seen in people taking PrEP. Most cases are of individuals who started taking PrEP when they were already in the very early stages of HIV infection.

And a new study has shown that in these rare cases, the resistance doesn’t last. Researchers followed nine people who had used PrEP and had drug resistance. Each one stopped taking the PrEP drugs as soon as they realised that they were HIV positive.

Six months later, highly sensitive tests were unable to find the resistant HIV in any of these individuals. Tests one and two years later had the same results.