“If everyone has the right to health, why are many of our friends dying from HCV?” asked Hidangmayum Umesh Sharma, treasurer of the Asian Network of People who Use Drugs. Asia is home to 38 percent of the estimated 130–170 million people worldwide chronically infected with hepatitis C virus (HCV).1, 2 Mr. Sharma is one of approximately five million people (15 percent of all those living with HIV/AIDS) who are co-infected with HIV and HCV.3
TREAT Asia Director of Research Dr. Nicolas Durier will lead the first regional HCV screening study and treatment demonstration project for HIV-positive patients.
HCV is a serious health threat and is particularly dangerous for people who are HIV positive. Around 75 percent of infected individuals develop chronic HCV, which can lead to cirrhosis—a potentially fatal condition that can result in liver failure and is a risk factor for liver cancer. HIV-positive patients who have progressed to AIDS and are co-infected with HCV have a 50 percent greater risk of mortality than HCV-uninfected patients.
HCV is curable with therapy in 50–90 percent of cases, depending on the virus genotype (strain) and patient characteristics, including ethnicity. Asian patients tend to have higher treatment response rates than Caucasian patients, for example.
However, treatment is costly and not routinely offered in resource-limited settings. “An outreach worker, who is the front-line service provider for HCV and HIV education, earns US$100 per month and would need to save all of his income for approximately 180 months just to buy medicine to treat his HCV,” said Mr. Sharma. Research on the burden of chronic HCV infection, disease severity, and the treatment needs of HIV co-infected patients in Asia is badly needed.
In 2013, TREAT Asia will initiate the first regional HCV screening study and treatment demonstration project for HIV-positive patients in Asia. Led by TREAT Asia Director of Research Dr. Nicolas Durier, and with scientific and biostatistics support from the Kirby Institute, Sydney, Australia, this innovative project will study the tolerability and effectiveness of HCV treatment in HIV co-infected patients within HIV clinics in Asia. The ultimate goal is to develop a pilot model of care for HCV treatment in resource-limited settings that can be replicated within the region. In addition, the project could generate data to bolster advocacy efforts aimed at securing commitments from governments and donor organizations to expand HCV treatment programs.
The screening study is being funded by the U.S. National Institutes of Health, and the treatment project will be supported by a donation of 200 courses of HCV treatment from Merck and Co. and preferentially priced HCV blood tests from Abbot Molecular. It will be implemented in Bangkok, Thailand, at the Thai Red Cross AIDS Research Centre; Hanoi, Vietnam, at the National Hospital of Tropical Diseases; Jakarta, Indonesia, at Cipto Mangunkusumo Hospital; and Kuala Lumpur, Malaysia, at the University of Malaya Medical Centre.
One of the study sites, the National Hospital of Tropical Diseases in Hanoi, Vietnam
“With hepatitis C, we are facing a massive epidemic,” said Dr. Durier. “Most people with this infection live in developing countries, and, while we know very effective therapy exists, only a handful of them can access treatment. Medicines have been prohibitively expensive, technical guidance is lacking, and political commitment and international funding are almost nonexistent. All of this needs to be urgently addressed before we are faced with a new epidemic of liver failure.”
1 World Health Organization (2011). Weekly epidemiological record. No 41, 86, 445–456. Available at http://www.who.int/wer/2011/wer8641.pdf.
2 Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, Alomair A, Amarapurkar D, Chen CH, Dou X, El Khayat H, Elshazly M, Esmat G, Guan R, Han KH, Koike K, Largen A, McCaughan G, Mogawer S, Monis A, Nawaz A, Piratvisuth T, Sanai FM, Sharara AI, Sibbel S, Sood A, Suh DJ, Wallace C, Young K, and Negro F. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver International. 2011 Jul; 31 Suppl 2:61-80.
3 Mauss S, Berg T, Rockstroh J, Sarrazin C, and Wedemeyer H, The Short Guide to Hepatitis C (2012 Edition) (The Flying Publisher, 2012), 11. Available at http://flyingpublisher.com/0011.php.