CAB55 – Hepatitis C co-infection, START study community feedback

UK-CAB 55: Hepatitis C co-infection

Friday 3 July 2015

Programme

09.30-09.45 Arrival
09.45-10.00 Welcome and introductions, UK-CAB updates
10.00-11.30 START and the implications to BHIVA treatment guidelines – Simon Collins
11.3-11.45 BREAK
11.45-12.30 Hepatitis C genotypes – Robert Fieldhouse
12.30 -14.00 LUNCH
14.00-15.15 DAAs for HCV infection – are we there yet? – Dr Sanjay Baghani, Royal Free Hospital
15.15-15.20 BREAK
15.20-16.00 ChemSex and HIV/HCV co-infection – David Stuart, 56 Dean Street Clinic
16.00-16.15 Conference feedback – BHIVA
16.15-16.45 Member updates, AOB
16.45 Meeting close

Presentations from this meeting

START and the implications to BHIVA treatment guidelines
Hepatitis C genotypes
DAAs for HCV infection – are we there yet?
ChemSex and HIV HCV co-infection
Conference feedback – BHIVA

Background reading

BMS  failed to confirm their attendance at the next meeting. We   had to re-schedule the programme. Simon Collins has been involved with the START study. He reported back and lead a discussion on the impact to the BHIVA treatment guidelines. START is one of the most significant study results and will change treatment globally.

Here is the pre-meeting reading available including a non-technical Q&A.

Breaking news: what do the START results mean for HIV positive people.
http://i-base.info/breaking-news-what-do-the-start-results-mean-for-hiv-positive-people

i-Base Q&A on the START study results.
http://i-base.info/i-base-qa-on-the-start-study-results

HCV Introduction 
The hepatitis C virus (HCV) can cause liver damage. HCV is transmitted primarily by direct blood-to-blood contact. There are 130-150 million people are living with HCV worldwide. 350,000 – 500,000 people die from Hepatitis C liver related disease each year. It is estimated around 214,000 people are living with Hepatitis C in the UK. In Scotland, it is estimated that approximately 37,000 people are living with Hepatitis C in Scotland. 50% of those may be infected but undiagnosed. (HPE report 2014)

This is the third UK-CAB HCV meeting. The last meeting was in 2013 which discussed was research into new drugs. A lot has changed since then. In 2011 the standard treatment for HCV was Pegylated interferon – a once weekly subcutaneous injection for immune activation and Ribavirin, an oral antiviral. In 2013, Boceprevir and Telaprevir were approved for GT1 only, which had terrible side effects.

In 2015, there are new drugs that are simple, oral with no side effects. These new HCV drugs have over a 90% cure rate. Treatment with these new hepatitis C therapies will vary based on the genotype, presence or absence of cirrhosis, and transplant status. Patients with HIV co-infection might also be treated.

So why are we still discussing HCV? The biggest problem has been access. The new very efficacious drugs are very expensive. Activists have and are still fighting for access for all who need these drugs.

Below are some videos and articles to watch and read before the meeting.

CROI 2015
HCV: care in the inteferon-free era – webcast 29mins
Case presentation by Dr Arthur Kim where panellists discuss case leading to HCV diagnosis in a young woman who has never used drugs. The discussion has some technical data, but can be understood fairly easily.
http://www.croiwebcasts.org/console/player/25524?mediaType=slideVideo&

HCV: Trials and Tribulations to triumph – abstract by activist Tracy Swan from Treatment Action Group showing that HCV can now be cured with the new direct-acting antiviral (DAA) combinations
http://www.croiconference.org/sessions/hepatitis-c-virus-trials-and-tribulation-triumph

Videos – watch these and then read the documents

HCV lifecycle (2.10mins)
https://www.youtube.com/watch?v=ZJ0wQ4sTAwQ

What is HCV? 2min video – NHS Choices video give the facts of what HCV is very simple language. It has patients sharing their experiences of living with HCV. There are other links on the same page on how you get HCV, symptoms, how to avoid it, treatment, etc.
http://www.nhs.uk/hepatitisc/what-is-hepatitisc/Pages/the-facts.aspx

Activist videos
Protesting Gilead’s Outrageous Hep C Treatment Pricing in New York (2014) (6mins)
https://www.youtube.com/watch?v=T5AEA2s6_Tg

ACT-UP Paris demonstrate at Gilead offices (2013) 5mins
https://www.youtube.com/watch?v=0XtiHqhf-_k

HCV background
Hepatitis C, the basics (Waverly Care, Scotland) – this covers basic introduction to HCV, symptoms, transmission, treatment, transmission, UK and Scotland statistics and a worldwide overview of HCV.
http://www.waverleycare.org/about-hiv-hepetitus-c/hepatitis-c/basics/

Link to report by Public Health England: Hepatitis C in the UK 2014

Guide to HIV and HCV coinfection(i-Base)
This guide is selected as pre-reading because the language is non-technical and has good background information on HCV (published November 2013).  If this is too long to read all of it, please see these sections.
First questions
HIV, HCV and sex – including safer HCV sex for gay men
How response to HCV treatment is measured
Research into new drugs

Hepatitis C genotypes
http://aidsinfonet.org/fact_sheets/view/674

HCV treatment and treatment as prevention
How response to HCV treatment is measured – this is a section from the HIV i-Base treatment guide. It has the terms used for HCV treatment. It also explains how HCV treatment works for different genotypes.
http://i-base.info/guides/hepc/measuring-response

Financial support

The UK-CAB receives unrestricted funding from some pharmaceutical companies towards the direct costs of holding four meetings each year. This funding supports the travel and accommodation costs for members to attend from outside London, plus the cost of catering.

The content, programme and agenda for meetings is decided by the UK-CAB steering group in consultation with the wider membership. Funding is unconnected to meeting content.

We believe that manufacturers who currently develop and market medicines have a responsibility to actively engage with advocacy organisations and that HIV positive people and their advocates should be able to directly question manufacturers about the safety and efficacy of their products and proposals for future research.

For a list of companies that support the UK-CAB please see the “about us” page.

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Published: July 10, 2015
Last edited: July 10, 2015