3rd International HIV/Viral Hepatitis Co-Infection Meeting
HIV/Viral Hepatitis: Improving Diagnosis, Antiviral Therapy and Access
17 July 2016, Durban, South Africa
By Rachel Matteau Matsha1 and Tongai Maponga2
1 Urban Futures Centre, Durban University of Technology, South Africa ([email protected])
2 Faculty of Medicine and Health Sciences, University of Stellenbosch, South Africa ([email protected])
See the webcast from the report back session (by Tongai Maponga) below and download the presentation slides here
The theme of the 3rd International HIV/Viral Hepatitis Co-Infection Meeting was Improving Diagnosis, Antiviral Therapy and Access. Objectives included: presenting evidence on the latest therapies for HIV/viral hepatitis; identifying challenges and successes in scaling up diagnosis, screening, antiviral treatment and prevention of viral hepatitis; and advancing the agenda for viral hepatitis elimination. Discussions centred on the six key interventions outlined by the World Health Organization’s (WHO’s) Global Strategy on Viral Hepatitis: hepatitis B vaccination (including birth dose); safe injection practices plus safe blood; harm reduction for injection drug use; safer sex; hepatitis B treatment; and hepatitis C cure.
Recognizing that the burden of HIV-hepatitis B virus (HBV) co-infection remains a global challenge, the need to implement routine screening of HBV in people living with HIV was emphasized, as was the call for routine maternal screening, especially in low- and middle-income countries (LMICs). To eliminate mother-to-child transmission, global implementation of birth dose HBV vaccine should be implemented without further delay. Post-vaccine serological testing (PVST) for infants 1-2 months after the last vaccine is necessary to confirm effective responses to the vaccine and to identify infected children for whom vaccination may not have been effective. In particular, HIV/HBV co-infected children are more vulnerable to sub-optimal responses to HBV vaccines and may need booster vaccinations. There is also a need for comprehensive follow up of people with chronic hepatitis infections; increased efforts to employ routine surveillance for hepatocellular carcinoma and other consequences of chronic HBV infection were recommended.
There is a hidden HCV epidemic among people who inject drugs (PWID) as they often cannot and do not access testing and treatment services where these exist because drug use is criminalized. There are gaps in data on the epidemiology of HCV in Africa and beyond. However, populations of PWID do exist in sub-Saharan Africa. Limited data regarding HCV and HIV infections (and co-infection) among PWID on the continent is an obstacle to improving access to and quality of viral hepatitis-related health services for PWID. Similarly, limited awareness and access to testing, diagnosis and treatment of HCV are major barriers to the good management and elimination of the disease. The role of resistance and resistance testing for managing HCV in the light of the availability of direct-acting antivirals (DAAs) for treating HCV is another issue to consider. Failure to achieve a sustained virological response (SVR) using interferon-free DAAs usually involves HCV variants resistant to one or more DAAs. However, the addition of ribavirin and extending treatment duration often improve treatment outcomes.
In the light of the upcoming release of the WHO testing guidelines for viral hepatitis, there is a shift towards taking a public health approach and focusing on LMICs to deliver, at scale, cost-effective, simplified and standardized treatment and national prevention programmes and surveillance strategies. That HCV can now be cured is a true game changer. However, several challenges remain, including: the need for WHO prequalification of testing devices to occur more efficiently; the need for governments to register for access to subsidized DAAs against HCV; and providing access to affordable treatment for people with HBV mono-infection. Governments should embrace scientific evidence and provide treatment to people living with HCV in line with WHO’s targets for the reduction by 2030 of hepatitis B and C infections by 90% and mortality by 65%. Pharmaceutical companies are encouraged to continue sharing their patents through the Medicines Patent Pool so that governments of LMICs can have access to pan-genotypic drugs at a reduced cost. Innovative models to improve diagnosis and treatment within LMICs were presented, including public-private partnerships. People living with viral hepatitis and others involved in community-level work with PWID and other key populations are central to the response. Governments are urged to put an end to discrimination against and criminalization of PWID and to provide HCV treatment to all. Importantly, stigma and discrimination against people living with HBV must end, and birth dose HBV vaccination should urgently be made universal.