1 / 20

Access to HCV treatment for people with HIV/HCV

Access to HCV treatment for people with HIV/HCV. Professor Gregory Dore Viral Hepatitis Clinical Research Program, Kirby Institute, The University of New South Wales & St Vincent’s Hospital, Sydney. Disclosures. Burden of HIV and HCV. MSM. PWID. HIV. HCV. HCV. HIV.

airlia
Download Presentation

Access to HCV treatment for people with HIV/HCV

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Access to HCV treatment for people with HIV/HCV Professor Gregory Dore Viral Hepatitis Clinical Research Program, Kirby Institute, The University of New South Wales & St Vincent’s Hospital, Sydney

  2. Disclosures

  3. Burden of HIV and HCV MSM PWID HIV HCV HCV HIV

  4. Without effective HIV management, including adherence to antiretroviral therapy, consideration of HCV treatment is problematic

  5. HIV mortality by CD4 cell count /100 py DAD Arch Intern Med 2006

  6. Directly observed ART in opiate pharmacotherapy setting Berg KM. CID 2011;153:936-943

  7. Directly observed ART in opiate pharmacotherapy setting Berg KM. CID 2011;153:936-943

  8. The complexity and lack of tolerability of IFN-based therapy mean that a major impact on HCV disease burden among PWID populations will not be achieved

  9. HCV treatment uptake in HIV/HCV F0/1 = 30 Patient refusal = 10 ESLD = 19 Advanced HIV = 16 Psych co-morb = 6 Drug/alcohol = 6 HCV RNA –ve = 9 Mehta SH et al, AIDS 2006;20:2361-2369

  10. The advent of IFN-free direct acting antiviral therapy will provide the feasibility to rapidly scale-up HCV treatment programs for PWID

  11. DAA development timeline PEG-IFN + RBV PEG-IFN + RBV + DAA Treatment complexity DAA combination 2010 2011 2012 2013 2014 2015 Dore GJ. Med J Aust 2012;196:629-632

  12. IFN-free DAA therapy: genotype 1, treatment naïve SVR 4-12 % EASL 2012

  13. Phase I (IFN-based therapy, 2012-2014): Treat primarily as liver disease Target treatment to F2-4 Increase disease staging (i.e. Fibroscan assessment) Community-based disease staging (i.e. Portable Fibroscan) Expand treatment access: Prisons, Methadone clinics, Rural & Regional, Nurse Practitioners/Consultants, GPs , ID specialists Phase II (IFN-free therapy, 2014 and beyond): Treat primarily as infectious disease Treat all stages of disease Major involvement of infectious disease and primary care clinics, with advanced disease in liver clinics Strategies to optimize adherence ? Treatment as prevention HCV treatment strategies

  14. Hepatic elastography Vergniol J et al. Gastroenterology 2011:140:1970-1979.

  15. Progression to ESLD, HCC, liver-mortality Johns Hopkins HIV/HCV Clinic (n=631) Baseline liver biopsy 1993-2009; Median follow-up = 5.4 years /1,000 py Sulkowski M et al, CROI 2010

  16. Community-based HCV treatment Arora S E et al. Hepatology 2010; 52:1124-1133

  17. Without removal of barriers to treatment access, including DAA treatment price reform, the impact of improving therapy on HCV disease burden will be modest

  18. Patient directed: Improved education and counseling Evaluation of peer-based support Management of co-morbidities, particularly psych and drug and alcohol Provider directed: Improved education and training Expansion of practitioner base: addiction medicine, ID, primary care Incentives for involvement in HCV treatment and care Infrastructure based: Improved HCV screening and assessment Development of multidisciplinary teams Community based programs, including telehealth/telemedicine Removing barriers to treatment access

  19. Price of first generation ART

  20. Impact of improving HCV treatment Thomas DL. Lancet 2010;376:1441-1442

More Related