TREAT Asia Launches a New Hepatitis C Training Series for Clinicians
About five million people living with HIV, or 15% of the total HIV-positive population, are co-infected with the hepatitis C virus. The liver disease often caused by hepatitis C infection progresses more quickly in individuals co-infected with HIV, and, as increased access to antiretroviral therapy (ART) in the Asia-Pacific allows more patients to control their HIV infection, hepatitis C-related liver disease is becoming an increasingly common cause of mortality among HIV-positive patients. However, because available hepatitis C treatments are complex and/or expensive, access is limited in most resource-limited settings, and many physicians have little knowledge about how to treat co-infected patients.
TREAT Asia’s “Management of HIV/Hepatitis C Co-Infection” training series offers clinicians the most up-to-date information about how to manage co-infection and treat it with the combination regimen, pegylated interferon (an injected drug) and ribavirin (an oral pill). “Using hepatitis C drugs is not easy, and it’s important to equip HIV physicians and care providers with better practical knowledge,” says Dr. Nicolas Durier, TREAT Asia research director.
TREAT Asia held its first hepatitis C management training in Hanoi, Vietnam, in July, and two more are scheduled to take place in September in Jakarta, Indonesia, and Kuala Lumpur, Malaysia. The trainings attract HIV care providers from hospitals in multiple areas of each country, broadening the scope of their impact. During the trainings, providers learn about HIV/hepatitis C co-infection epidemiology, the stages of hepatitis C and when to start treatment, and how to manage testing, treatment, and treatment side effects. “The training course is very impressive and important to all the participants, and it will help improve the clinical practice in their respective hospitals,” says Dr. Nguyen Van Kinh, director of the National Hospital of Tropical Diseases, who attended and spoke at the training in Hanoi.
In addition to improving physicians’ knowledge of hepatitis C treatment, TREAT Asia and its civil society partners have been advocating for policy changes and cost reductions that would increase the availability of hepatitis C treatment in the Asia-Pacific. In the past year, the World Health Organization (WHO) added pegylated interferon and ribavirin to its list of essential drugs, and Thailand added the treatment combination to its universal healthcare scheme, meaning the cost of most aspects of hepatitis C diagnosis and treatment will be covered by the government’s plan. “It’s hard to know how much Thailand’s new policy will influence other countries in the region,” says Dr. Durier. “But these trainings will build advocacy for making the treatments available in other countries and increase local capacity to deliver them.”
A new hepatitis C treatment, Solvaldi® (sofosbuvir)—a daily pill that is easy to administer, has few drug interactions with HIV medicines, and has higher rates of curing hepatitis C than previous combination regimens—is not currently available in resource-limited settings, due to its high cost. Negotiations are underway to make a more affordable generic version available. However, it is not expected to be ready until 2016, and distribution may be limited to a short list of lower-income countries, depending on pharmaceutical licensing agreements. “Physicians and clinicians should be ready to provide treatment and care to co-infected patients with the combination regimen that is currently more affordable and accessible,” says Phiangjai Boonsuk, TREAT Asia education project manager.