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Prevention, Treatment and Care of Hepatitis C among People W ho I nject D rugs

Prevention, Treatment and Care of Hepatitis C among People W ho I nject D rugs. Jason Grebely, PhD Senior Lecturer Viral Hepatitis Clinical Research Program The Kirby Institute University of New South Wales. Prevention, Treatment and Care of HCV among PWID. Issues.

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Prevention, Treatment and Care of Hepatitis C among People W ho I nject D rugs

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  1. Prevention, Treatment and Care of Hepatitis C among People Who Inject Drugs Jason Grebely, PhD Senior Lecturer Viral Hepatitis Clinical Research Program The Kirby Institute University of New South Wales

  2. Prevention, Treatment and Care of HCV among PWID Issues • The burden of HCV in many countries is driven by PWID and continues to grow • Transmission of HCV continues among PWID • Although HCV treatment uptake is low due to a number of barriers, treatment willingness is high among PWID • HCV treatment is effective among PWID • Strategies to enhance HCV assessment and treatment among PWID are required

  3. PWID are the core of the HCV epidemic and “ageing cohorts” of PWID will lead to considerable advanced liver disease burden

  4. PWID are at the core of the HCV epidemic PEOPLE LIVING WITH HCV INFECTION 1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol 2013. 2) Grebely J and Dore GJ Antiviral Research 2014. In Press.

  5. PWID are at the core of the HCV epidemic 80% OF NEW INFECTIONS OCCUR AMONG CURRENT PWID IN MANY COUNTRIES PEOPLE LIVING WITH HCV INFECTION 1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol 2013. 2) Grebely J and Dore GJ Antiviral Research 2014. In Press.

  6. PWID are at the core of the HCV epidemic 60% • OF EXISTING INFECTIONS AREAMONG CURRENT • & FORMER PWID IN MANY COUNTRIES PEOPLE LIVING WITH HCV INFECTION 1) Hajarizadeh B, et al. Nature Rev Gastroenterol Hepatol 2013. 2) Grebely J and Dore GJ Antiviral Research 2014. In Press.

  7. HCV is a major public health problem among PWID Eastern Europe 2.3m North America 1.7m • Global estimation: 10.0 million PWIDs (range 6.0–15.2) in 2010 were HCV antibody positive • Global prevalence: 67.0% East and Southeast Asia 2.6m Sub-saharan Africa 0.8m Latin America 1.7m Nelson PK, et al. Lancet 2011

  8. Disease burden due to HCV is substantial Hepatitis C virus Streptococcal pneumonia Human papilloma virus Hepatitis B virus E. Coli HIV/AIDS Staphylococcus aureus Influenza C. Dificile Rhinovirus Respiratory syncytial virus Parainfluenza virus Years of Life Lost Group B Strep Group A Strep Year-equivalents of reduced functioning Haemophilus influenza Tuberculosis Legionella Chlamydia Adenovirus Gonorrhea 0 2000 4000 6000 8000 1000 Health Adjusted Life Years (HALYs) Kwong et al PLoS One 2012

  9. Liver-related mortality increases with age Deans G, et al CMAJ Open. 2013

  10. HCV transmission continues to occur among PWID

  11. Harm reduction interventions have been less effective for HCV • Higher prevalence of HCV infection (67% vs. 20%) • Higher risk of infection (3-5% for HCV vs 1-2% for HIV) Mehta SH, Journal of Infectious Diseases 2011.

  12. Interventions to prevent HCV among IDUs • Opioid substitution therapy1-2 • High NSP coverage2 • Multiple combined interventions most effective2-3 1) Nolan S, et al. Addiction 2014 (In Press); 2) Turner KM, et al. Addiction 2011; 3) Hagan H, et al. Journal of Infectious Diseases 2011.

  13. HCV treatment uptake among people who inject drugs is low, due to a number of barriers at the levels of the system, provider and patient

  14. PWID have a high willingness to receive HCV treatment PWID LIVING WITH HCV INFECTION

  15. PWID have a high willingness to receive HCV treatment 80% OF PWID ARE WILLING TO RECEIVE HCV TREATMENT PWID LIVING WITH HCV INFECTION Stein MD,Drug and Alcohol Dependence 2001. Walley AY, J Substance Abuse Treatment 2005. Doab A, Clinical Infectious Diseases 2005. Fischer B, et al. Presse Med 2005. Strathdee S, et al Clinical Infectious Diseases 2005. Grebely J, et al. Drug and Alcohol Dependence 2008. Alavi M, et al. Clinical Infectious Diseases 2013.

  16. Treatment uptake among PWID is still low…. 80% OF PWID ARE WILLING TO RECEIVE HCV TREATMENT 1-2% are treatedeach year PWID LIVING WITH HCV INFECTION 1) Grebely J. J Viral Hepatitis 2009. 2) Mehta S. J Community Health 2008. 3) Iversen J, J Viral Hepatitis. 2013. 4) Alavi M. Liver International. 2014.

  17. Barriers to HCV assessment and treatment

  18. Barriers to HCV assessment and treatment PATIENT

  19. Barriers to HCV assessment and treatment PROVIDER

  20. Barriers to HCV assessment and treatment SYSTEM

  21. HCV treatment can be highly successful among PWID

  22. HCV treatment is effective in PWID - PEG-IFN/RBV Dimova R, et al Clinical Infectious Diseases 2013

  23. HCV treatment is effective in PWID - PEG-IFN/RBV Dimova R, et al Clinical Infectious Diseases 2013

  24. Strategies to enhance HCV assessment and treatment among PWID

  25. The HCV Care Cascade – PWID in Australia HCV TESTING ASSESS & MONITOR ENGAGE IN TREATMENT ENHANCE RESPONSE 80% 40% 10% 5%

  26. The HCV Care Cascade – Future requirements HCV TESTING • guidelines • systematic programs for HCV screening and diagnosis • point-of-care HCV testing

  27. The HCV Care Cascade – Future requirements HCV TESTING ASSESS & MONITOR • guidelines • systematic programs for HCV screening and diagnosis • point-of-care HCV testing • education • guidelines • infrastructure for HCV services • non-invasive fibrosis assessment

  28. First global recommendations for HCV among PWID Robaeys* and Grebely*, et al. Clinical Infectious Diseases 2013

  29. The HCV Care Cascade – Future requirements HCV TESTING ASSESS & MONITOR ENGAGE IN TREATMENT • linkage to care • multidisciplinary care models • effective, tolerable, simple, short-duration HCV therapy • guidelines • systematic programs for HCV screening and diagnosis • point-of-care HCV testing • education • guidelines • infrastructure for HCV services • non-invasive fibrosis assessment

  30. The HCV Care Cascade – Future requirements HCV TESTING ASSESS & MONITOR ENGAGE IN TREATMENT ENHANCE RESPONSE • linkage to care • multidisciplinary care models • effective, tolerable, simple, short-duration HCV therapy • guidelines • systematic programs for HCV screening and diagnosis • point-of-care HCV testing • education • guidelines • infrastructure for HCV services • non-invasive fibrosis assessment • strategies to enhance adherence • risk reduction to prevent reinfection

  31. Efficacious treatments do not work if not given….. 95% 40% 1998 55% 2002 70% 2012 90% 2018 Efficacy of treatment (%) of infected people were not receiving treatment in 2012 (projected) Amount of infected people treated (%) Thomas DL Nature Medicine 2013. Grebely J and Dore GJ Antiviral Research 2014.

  32. Acknowledgements ArudZentrenfürSuchtmedizin Dr. Philip Bruggmann University of New South Wales The Kirby Institute Prof. Gregory Dore INHSU executive board Markus Backmund, Germany Julie Bruneau, Canada Olav Dalgard, Norway Greg Dore, Australia Jason Grebely, Australia Matt Hickman, UK Alain Litwin, US Geert Robaeys, Belgium Tracy Swan, US

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