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NHIVNA Hep C - HIV Co-infection study day - rapid notes

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Mark Platt
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Posts: 290
NHIVNA Hep C - HIV Co-infection study day - rapid notes
Posted on: June 26 2014, 10:32 am

Just thought I'd share some quick notes from yesterday's study day. Slides etc will be available on the NHIVNA website after the conference.

Vivian Hope: Over-view of Hep (B, C) & HIV
Hep C
- Estimate of 215K Hep C in UK, prevalence low, below 1%
- most Hep C via IDU
- 2 in 5 infected will live with Hep C
- SA, Africa, China, SE Asia higher rates of Hep C
- MSM is a higher prevalence group, 2%, 6-7 times greater for HIV+, although prevalence seems to be less than predicted
Hep B
- low prevalence, most people will clear infection
- current level of acute infections level, fallen since 1980
- most infections sexually related, a few IDU (was the main route in 1980s)
- targeted vaccination programme seems to be working, especially for IDU, however not so for non-psychoactive injectors, eg steroid users
Co-infection
- if have 1 infection much more likely to have 1 or both of other
- HIV: MSM, 1 in 20 likely to have Hep C; IDU 3 in 4 to have Hep C; both group at higher risk of Hep B
- overlaps: MSM and PWID are at high risk of all three, HIV/Hep C most likely in MSM/PWID; people with links to high prevalence counties also more likely to have co-infection
Q:
- Why don't vaccinate everyone for Hep B? Not cost-effective for everyone, but new vaccines might lead to being included as childhood vaccination, some countries do give at adolescence, but tends to rule out those most likely to become IDU

NB: Vivian very supportive of third-sector groups doing prevention work with specific groups

Ricky Gellissen: what can Hep C learn from HIV C
- primarily drawn on MSM data
- co-infection is actually quite common, 9M people world wide
- Hep C epidemic greater than HIV
- common themes: triple therapy (DDIs, adherence), prevention, legal issues, including reckless transmission
- Hep C treatment options still well behind those for HIV; still waiting for new treatments to receive NICE approval
- Liverpool website now includes Hep C drugs to cover co-infection
- in Hep C looking for '80-80-80' adherence, 95% adherence is required to achieve undetectable in 80% of patients; challenge is to ensure other prescribers are aware of Hep C treatment and prescribe accordingly, requires good communication with primary care!
- barriers to adherence are: inconvenient dosing and food requirements, side effects, forgetfulness including sleeping through dosing time and running out of drug
- good adherence slide: materials need to be appropriate and accessible,

Susan Kidger, Lead hepatitis nurse, Nth Manchester: new treatments for hep c - NB: slides from drug comps
- Licensed but awaiting NICE approval: Sofosbuvir, Simeprevir; awaiting license: Daclatastivir, Ledipasivr
- Sofosbuvir: 1 daily, well tolerated, no DDIs, good safety profile, no food effect, high barrier to resistance, 15 centres licensed to prescribe under expanded access, between 12 and 24 week regimens
- Daclastavir: pan-gentotypic, clinic effective in hard to reach patients, well tolerated except for two HIV meds, clearance in cirrhotic patients is 91%, combination regimen
- Simeprevir: needs to be used with peg and ribavirine, only for geno 1 & 4, combination regimen, 24 weeks, will most likely replace telaprovir, currently priced at same level, and will need to be augmented by standard of care treatment, 3 discontinue rules, need screening at start for NS3 Q80K polymorphism (paid for by company) must be taken whole with food, some HIV drug interactions, Etravine, Dar, Raltegravir, Tenofovir, administration like o be only available at approved centre which must have a hepatologist
- Ledipasivr: once daily, no DDIs, can also be combined with Sofosbuvir as a fixed dosed oral combination, 8 week course, do need to be careful with anticonvulsants, anticomybacterials, herbal HIV PIs
- which to choose: will be lots of options, but will be dependent upon cost, eg range between 23k and 35k (PA), Sofosbuvir 35, Daclastavir 35, Simeprevir 23K, Ledipasivr as yet price not set; prices in UK are cheaper than other places, and NICE have asked for more info on Sofosbuvir
- there will also be issues relating to the ease of treatment, i.e. how many times will people be able to be access further treatment
- cost savings may come from fewer clinic visits, and future possibilities for GP prescribing
- see Lone Star trial in US

Malcolm Macartney, Janssen: The Pipeline
- Simeprivir just launched, in talks with NHSE to enable to bypass NICE
- new formula of Cobicistat with darunavir to be available
- working with ViiV on darunavir and rilpiravir combination
Logged

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