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Towards Global Viral Hepatitis Elimination for All Patients in All Income Settings

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Towards Global Viral Hepatitis Elimination for All Patients in All Income Settings Towards global viral hepatitis elimination for all patients in all income settings Guest Editors: Marina B Klein, Karine Lacombe Supplement Editor: Marlène Bras Volume 21, Supplement 2, April 2018 Support The publication of this supplement was made possible with support from the CIHR Canadian HIV Trials Network, the European AIDS Clinical Society, the European Association for the Study of the Liver, the US National Institute on Drug Abuse, Abbott, AbbVie, Cepheid, Hetero Drugs, MSD and Pharco; all contributing their support through the 4th International HIV/Viral Hepatitis Co-Infection Meeting Towards global viral hepaঞ ঞ s eliminaঞ on for all paঞ ents in all income seম ngs Guest Editors: Marina B Klein, Karine Lacombe Supplement Editor: Marlène Bras Contents The Rocky Road to viral hepatitis elimination: assuring access to antiviral therapy for ALL coinfected patients from low- to high-income settings Karine Lacombe and Marina B Klein 1 How far are we from viral hepatitis elimination service coverage targets? Yvan J-F Hu n, Marc Bulterys and Go ried O Hirnschall 4 Hep-CORE: a cross-sectional study of the viral hepatitis policy environment reported by patient groups in 25 European countries in 2016 and 2017 Jeff rey V Lazarus, Samya R Stumo, Magdalena Harris, Greet Hendrickx, Kris na L Hetherington, Mojca Ma cic, Marie Jauff ret-Rous de, Joan Tallada, Kaarlo Simojoki, Tatjana Reic and Kelly Safreed-Harmon on behalf of the Hep-CORE Study Group 9 Approaches for simplified HCV diagnostic algorithms Slim Foura , Jordan J Feld, Stéphane Chevaliez and Niklas Luhmann 17 Linkage and retention in HCV care for HIV -infected populations: early data from the DAA era Rachel Sacks-Davis, Joseph S Doyle, Andri Rauch, Charles Beguelin, Alisa E Pedrana, Gail V Ma hews, Maria Prins, Marc van der Valk, Marina B Klein, Sahar Saeed, Karine Lacombe, Nikoloz Chkhar shvili, Frederick L Al ce and Margaret E Hellard 26 Treatment advocate tactics to expand access to antiviral therapy for HIV and viral hepatitis C in low- to high-income settings: making sure no one is left behind Céline Grillon, Pri R Krishtel, Othoman Mellouk, Anton Basenko, James Freeman, Luís Mendão, Isabelle Andrieux-Meyer and Sébas en Morin 38 What do clinicians need to watch for with direct-acting antiviral therapy? Alessio Aghemo, Lionel Piroth and Sanjay Bhagani 44 Is hepatitis C virus elimination possible among people living with HIV and what will it take to achieve it? Natasha K Mar n, Anne Boerekamps, Andrew M Hill and Bart J A Rijnders 51 Research gaps in viral hepatitis Anders Boyd, Léa Duchesne and Karine Lacombe 60 Volume 21, Supplement 2 April 2018 Lacombe K and Marina BK Journal of the International AIDS Society 2018, 21(S2):e25073 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25073/full | https://doi.org/10.1002/jia2.25073 EDITORIAL The Rocky Road to viral hepatitis elimination: assuring access to antiviral therapy for ALL coinfected patients from low- to high-income settings Karine Lacombe1,2§,* and Marina B Klein3,4,* §Corresponding author: Karine Lacombe, Service de maladies infectieuses et tropicales, Hopital^ St Antoine, 184 rue du Fbg St Antoine, 75012 Paris, France. Tel: +33 1 49 28 31 96. ([email protected]) *These authors have contributed equally to the work. Keywords: antivirals; diagnostic; guidelines; hepatitis B; hepatitis C; HIV; key populations; prevention Received 18 January 2018; Accepted 19 January 2018; Published 9 April 2018 Copyright © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited." 1 | INTRODUCTION pave the Rocky Road to viral hepatitis elimination by leaving no one behind (https://www.iasociety.org/Co-Infections/Hepa Chronic viral hepatitis is a leading cause of morbidity and titis). This special issue of the Journal of the International AIDS mortality from liver disease worldwide, ranking among the top Society has gathered landmark papers on viewpoints, reviews 10 causes of global mortality in 2013 [1]. Chronic hepatitis B and original data that were presented and debated during the (CHB) and C (CHC) are responsible for most of this liver dis- Workshop. It provides a comprehensive overview of the chal- ease burden with CHC being predominant in Europe and the lenges faced by scientists, stakeholders and the community in Americas and CHB more frequent in the other parts of the addressing questions of why, how and when viral hepatitis will world. For years, the response to chronic viral hepatitis has be eliminated, with a specific focus on HIV coinfection and key been hampered by lack of public knowledge, inadequate populations. screening policies, poor treatment access and low treatment As with HIV infection, the approach to viral hepatitis elimi- efficacy [2]. However, global inertia has come to a halt in large nation necessitates increasing prevention and implementing part due to the advent of curative anti-HCV direct acting action along all the points of the care and treatment cascade. antivirals (DAAs) that have the potential to radically impact Specific service targets will need to be met along all these the HCV epidemic. The resulting paradigm shift in CHC care points to ensure success. In the commentary by Hutin and col- and management has mobilized involvement of international leagues, it is evident that considerable progress is being made global health organizations such as the World Health Organi- with respect to implementing some existing tools for preven- zation (WHO) in the fight against viral hepatitis. In 2016, the tion such as improved blood and medical injection safety and World Health Assembly of the United Nations called for the birth dose vaccination for HBV, whereas harm reduction tar- elimination of viral hepatitis as a public health threat, with a gets are falling far short of requirements [6]. Diagnosis rates 90% reduction in cases of viral hepatitis and 65% reduction in remain appallingly low and without rapid increases in the num- mortality by 2030 [3]. Because of shared routes of transmis- ber of people tested and diagnosed, little progress in the very sion, more than four million individuals are estimated to be low treatment rates can be expected. dually infected with the human immunodeficiency virus (HIV) One of the key aspects for successful implementation of and either CHC or CHB worldwide [4,5]. Most of these peo- the WHO global health sector strategy on HBV and HCV will ple belong to key populations such as men who have sex with be the establishment of national and local policies and pro- men (MSM) and people who inject drugs (PWID) where speci- grammes that support elimination efforts across sectors. fic interventions will need to be implemented to reach elimina- Lazarus and colleagues report on country-specific responses tion of viral hepatitis, including prevention of reinfection. to viral hepatitis (including public awareness and engagement Against this backdrop, a workshop preceding the opening of and the presence of explicit policies for prevention, diagnosis, the ninth IAS conference of HIV Science was held in Paris in monitoring and treatment) from the unique perspective of July 2017. The meeting brought together researchers study- patient groups in Europe (Hep-CORE) comparing 2016 and ing the epidemiology and modelling of viral hepatitis, profes- 2017 [7]. While, in general, there was a reported increase in sionals caring for those infected, as well as community policies and programmes for viral hepatitis over time, more researchers and advocates. The aim of the meeting was to than half of countries did not have national strategies in place 1 Lacombe K and Marina BK Journal of the International AIDS Society 2018, 21(S2):e25073 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25073/full | https://doi.org/10.1002/jia2.25073 to address these epidemics and programming gaps for preven- achieving HCV elimination in HIV-positive previously men- tion (e.g. needle exchange) and treatment were notable. The tioned MSM and previously mentioned PWID [12]. They also study also highlights the important gaps that remain for present a real world example from the Netherlands which engaging civil society in the efforts to eliminate viral hepatitis. demonstrates that a very rapid decline in HCV prevalence can To reach elimination of viral hepatitis, the first major obsta- be achieved in HIV-positive MSM through DAA scale up. Inci- cle is identification of the estimated 80% of HCV-infected per- dence appears to be declining as a result but likely will not sons globally who have not yet been diagnosed. Fourati and reach the 90% reduction in incidence required for elimination. colleagues review diagnostic algorithms that might simplify They conclude that elimination is achievable in these key pop- and enhance decentralized diagnostic testing, particularly in ulations, but that treatment alone, despite being cost effective, low- and middle-income settings [8]. For example, the develop- will be insufficient and must be paired with harm reduction ment of reliable HCV core antigen tests and new nucleic acid and behavioural changes to prevent reinfections. amplification technologies could permit a one-step screening Finally, in a commentary that aims to pave the future of and diagnosis strategy. The availability of pangenotypic antivi- research in the field of viral hepatitis, Boyd and colleagues ral therapy may soon obviate the need to perform HCV geno- highlight the main evidence gaps that still need to be filled so typing prior to treatment which could further simplify the United Nations for the Millennium goals of combating viral management. While promising, these new technologies are hepatitis may be reached [13]. More tools are needed for pre- currently too costly for widespread deployment.
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