Treatment of Acute HCV Advocated

(A report back on Sanjay Bhagani's session - Dynamics of Acute HCV in Western Europe‚Äč)

Sanjay Bhagani talked about the status of acute HCV in Western Europe: compliance with the Global Health Sector Strategy (GHSS) call for the elimination of viral hepatitis as a public health threat by 2030, and the WHO reports on the significant obstacles to that strategy which include underdiagnosis and poor uptake of treatment in those diagnosed.

The high risk of acquiring HCV amongst HIV+ MSM was detailed, resulting in acute outbreaks of HCV, including 29 cases in Australia. Acquisition of HCV was generally through MSM, rather than IVDU. The rates of late-relapse or re-infection with HCV after SVR are highest in the HIV/HCV co-infected group.

 

Dr. Bhagani then makes the case for treatment of acute HCV. Points include:

1) spontaneous clearance of acute HCV in the HIV/HCV- coinfected were rare.

2) acute HCV allows transmission of the vireamia to spread to the community

3) treatment is cost-effective; delay of treatment to after 6 months is associated with increased costs from development of chronic HCV complications and transmission.

4) increased uptake of treatment of HIV/HCV coinfected MSM led to the successful reduction of over 50% of newly acquired HCV infection (treatment as prevention).

 

In Australia, where recommendations for treatment of acute HCV are not yet well-delineated, we need to consider the challenges and issues outlined in the presentation's summary:

1) prediction of lack of spontaneous clearance of HCV leads to establishment of chronic infection and HCV treatment should be started immediately. (algorithm and treatment table provided)

2) increased treatment rates of acute HCV impacts in the number of new HCV infections

3) need for screening for HCV in PrEP users, HIV+ high risk MSM, and after the 1st episode of acute HCV.

 

Author bio: Board certified in Infectious Diseases by the American Board of Internal Medicine, Rudyard has worked in Infectious Diseases (including HIV) in New York, New Zealand and Australia. Rudyard is currently a Senior Lecturer University of Queensland Rural Clinical School, and an Infectious Disease Physician at Central Queensland Hospital and Health Services.