Action on hepatitis C: new drugs, new resources

HIV Australia | Vol. 11 No. 2 | July 2013

FINN O’KEEFE¹ profiles developments in hepatitis C treatment and health promotion.

In February, Federal Minister for Health, Tanya Plibersek, announced that two new hepatitis C (HCV) drugs, telaprevir and boceprevir, will soon be subsidised through the Australian Pharmaceutical Benefits Scheme (PBS).

The two direct acting antivirals (DAA) drugs are used to treat genotype 1 HCV, which affects more than half of the 226,700 Australians living with chronic hepatitis C.

It is anticipated that these new medicines could double the HCV cure rate and shorten treatment duration by up to six months.

The upcoming PBS approval for the ground-breaking new drugs was applauded by organisations that support people living with chronic hepatitis, including AIVL (the Australian Injecting and Illicit Drug Users League) and Hepatitis NSW.

Over the past 12 months, these organisations report that they have been receiving increasing requests from individuals living with genotype 1 HCV who need urgent access to treatment.

Early treatment is critical

Annie Madden, Executive Officer of AIVL, says that making these new treatments available quickly is critical, as many people in Australia with hepatitis C have been living with the disease for over 20 years and have already suffered substantial liver damage.

‘A significant number of people with genotype 1 hepatitis C have been being discouraged from commencing hepatitis C treatment due to the promise of the availability the new drugs with significantly higher efficacy rates,’ Annie Madden explains.

‘It is very good news indeed that these medications will now be made available to those who need them before they could become ineligible for treatment due to the stage of their liver disease progression,’ she concludes.

Stuart Loveday from Hepatitis NSW says that the upcoming PBS listing for the new DAA drugs presents an ideal opportunity for people living with HCV to talk to their GP about their treatment options.

‘Hepatitis NSW encourages people living with hepatitis C, and especially those who have had hepatitis C for many years, to talk to their doctor about getting a referral to see a specialist to have a FibroScan® liver assessment done,’ Mr Loveday says.

HCV and HIV co-infection

HCV infection can lead to liver cirrhosis and liver cancer. People with HIV / HCV co-infection are at particular risk, as the effect of HIV can accelerate progression of these diseases.

HCV has also been shown to complicate the treatment of HIV because people with liver damage are more likely to experience hepatotoxicity (liver toxicity) when taking antiretroviral medication.

At a symposium on the clinical experiences of telaprevir held in Sydney in February – funded by Janssen Pharmaceuticals (manufacturers of telaprevir) – a series of specific case studies, including HIV co-infection, were discussed.

These case studies highlighted specific complications of treatment with telaprevir, including consideration of contraindication with other medications and – in exceptional circumstances – preparation for emergency liver transplant if treatment fails.

Raltegrevir and tenofovir emtricitabine is the preferred combination of antiretrovirals for patients with HIV and HCV co-infection. Patients need to switch medication and be stabilised on the new combination several months before commencing treatment.

HCV and sexual transmission

Previously, sexual transmission of hepatitis C was thought to be rare.

More recently, there have been increases in the number of cases of HCV transmission attributed to sex among gay men and other men who have sex with men in Australia, particularly among men living with HIV.

These increases have also been reported in numerous locations overseas, including in the United Kingdom, Europe, and North America.

Sexually, unprotected anal sex is the risk for hep C. There are a number of activities that increase the risk, such as fisting, sex toys, group sex, and use of drugs for sex.

In May, the Australian Federation of AIDS Organisations (AFAO) launched a website, ‘The New Deal: Gay Men, Sex and Hep C’ (www.thenewdeal.org.au) that aims to provide gay men with information about sexual transmission of hepatitis C and how to prevent it, as well as information about testing for and treatment of hepatitis C, and HIV and hepatitis C co-infection.

Hepatitis C is a significant health issue in its own right but there are particular health concerns for those people living with HIV, as Robert Mitchell, President of the National Association of People with HIV Australia (NAPWHA) explains.

‘Having both HIV and hep C can have serious impacts on the health of HIV-positive people. It can make treating both viruses more difficult and can also increase the progression of hep C and liver disease.’

The New Deal covers a range of information for HIV-positive men relating to co-infection with hepatitis C including testing for hepatitis C, treatment for both viruses and prevention options. There are also a number of other activities and programs already happening and being planned around the country to address sexual transmission of hepatitis C in gay men, and specifically for HIV-positive gay men.

The New Deal website has been designed to act as an information source in its own right but also as a central portal to direct people to activities around the country.

Reference

1 With input from Ben Wilcock (AFAO), Andrew Little (Hepatitis Australia), David Pieper (Hepatitis NSW), AIVL and ACON.

Finn O’Keefe is Communications Officer at AFAO and an editor of HIV Australia.