Hepatitis C co-infection can be eliminated in people living with HIV in the United Kingdom by 2021, the British HIV Association (BHIVA) said today.
“The UK can be the first country to achieve microelimination of hepatitis C in those living with HIV, well ahead of WHO [World Health Organization] targets. We should seize this opportunity,” BHIVA said in a statement released today.
Speaking at last week’s British HIV Association Hepatology Highlights Meeting, Professor Graham Cooke of Imperial College, London, said that breaking down WHO targets for hepatitis C elimination into microelimination targets for individual populations such as people living with HIV would help to drive progress towards the larger target of treating 80% of those eligible for direct-acting antiviral treatment by 2030.
Public Health England estimated that approximately 3300 people with HIV were also living with hepatitis C in England at the beginning of 2016. Approximately half were receiving care in London and around 15% in Birmingham and Manchester. Since then, about half have been cured of hepatitis C, although in some regions – including Tayside in Scotland and the North East of England – almost all people with co-infection have already been cured.
BHIVA said this week that it wants to see every person living with HIV and hepatitis C assessed for direct-acting antiviral treatment by April 2019 and 80% cured by that point. By April 2020 BHIVA wants to see 90% of hepatitis C infections cured in people living with HIV and complete elimination the following year.
They say that progress towards curing hepatitis C in people living with HIV has been rapid over the past two years but reaching the last 20% of patients could be harder.
“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.”
Further progress towards microelimination in people living with HIV will also have an impact on new infections, as the number of people able to transmit hepatitis C falls. Prof. Cooke told the BHIVA meeting that preliminary evidence from the Netherlands and London shows that the incidence of hepatitis C has fallen in recent years, although more evidence is needed to set realistic targets for prevention.
He stressed that international networks among men who have sex with men play an important role in the ongoing incidence of hepatitis C in people living with HIV, and that an increasing proportion of new diagnoses of hepatitis C are cases of reinfection.
BHIVA warns that policies which deny treatment to newly infected people until chronic infection has been established, including in cases of reinfection after cure, have the potential to undermine progress towards microelimination.
“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 [people living with HIV].”