Dr Jerzy Jaroszewicz at the EACS Standard of Care meeting. Photo by Valentin Boboc.
Dr Jerzy Jaroszewicz of the Polish Association for the Study
of the Liver outlined issues related to HIV/hepatitis C co-infection.
Whereas the World Health Organization (WHO) target is for that by 2030 90% of
people with hepatitis C should know their status, this is only the case
for a third of people in Europe. And while the WHO target is for 80% of those
diagnosed to receive direct-acting antivirals (DAAs) by 2030, last year it was
estimated that 13% of those diagnosed received treatment (2.5% of all those with
The vast majority (93%) of those in the region who have
hepatitis C/HIV co-infection are former or current injecting drug users.
In Europe, Iceland is the first example of a country that
has implemented a national hepatitis C elimination plan targeted at, though not
exclusive to, injecting drug users. In January 2016 the country launched a
cohesive, multipronged approach that includes scale‐up of prevention, testing
and early treatment of hepatitis C in both hospital and community settings. To
implement this, a multidisciplinary public health model of care and co-operation
between government, health services, the penitentiary system and community
organisations was needed.
Modelling studies show that just making DAAs available is not sufficient to curtail the transmission of
hepatitis C in eastern Europe and central Asia. In Belarus, Georgia,
Moldova, Kazakhstan and Tajikistan, adding DAAs to current provision would only
reduce new hepatitis C infections by 1 to 14%, depending on the country.
In contrast simply
providing needle and syringe exchange would reduce infections by 10 to 25% and
adding opioid substitution therapy (OST) to that would reduce infections by
45 to 55%. Also providing DAAs to that would only lower infections by a further
5%. Targeted screening programmes would have a much greater impact.
Dr Michel Katzatchkine, UN Special Envoy on HIV in central
and eastern Europe, commented: “We’re in a region where 1.9 million people who
inject drugs have hepatitis C and 750,000 of those have HIV. One per cent of
them are accessing OST, and the average annual allocation of clean syringes is
15 each. This is a health emergency.”