Issue 21 / 4 June 2012

NEW drugs capable of curing 90% of hepatitis C virus infections should be available within the decade and community awareness campaigns are needed to maximise their benefits, according to experts in the field.

The comments come in response to a series of articles published in the latest MJA describing the potential for direct-acting antiviral (DAA) therapy to revolutionise hepatitis C virus (HCV) treatment.

A clinical focus article predicted that, by the end of this decade, we could see cure rates in excess of 90% from a single daily dose of oral medication, given over 6–24 weeks. (1)

The article’s author, Professor Gregory Dore, of the University of NSW’s Kirby Institute, told MJA InSight that given 20%‒25% of people who are infected in Australia have not been diagnosed, higher rates of screening and diagnosis were needed once the new treatments were readily available.

“These new treatments will be pretty close by the time we scale up community awareness, so we should start thinking about it now”, Professor Dore said.

He said a recent call by the US Centers for Disease Control to test all baby boomers for hepatitis C could be justified in the US, where it was estimated that up to 70% of HCV infections were undiagnosed. (2)

“We don’t need that strategy in Australia as we have a higher proportion of diagnosed infections and rates of screening are higher for our at-risk population.”

In his article, Professor Dore noted that in the past 12 months, several major milestones had been reached, including registration of the first two DAAs (telaprevir and boceprevir) by the Therapeutic Goods Administration earlier this year.

“The broad implementation of such therapeutic regimens has the potential to produce one of the major turnarounds in disease burden seen in public health and clinical medicine”, he wrote.

In an editorial in the same issue of the MJA, Professor Geoffrey McCaughan, head of the Liver Immunobiology Program at the Centenary Research Institute, predicted that we would have short-duration anti-HCV therapy with minimal side effects and cure rates of more than 90% within 5 years. (3)

“Within a few years we will have drugs that get rid of the infection quite quickly”, Professor McCaughan told MJA InSight.

Once that happened, a large public awareness campaign would be needed to extend the reach of the treatment.

“If these drugs reach their potential, once the infection has been identified, it can be eradicated”, he said.

Treating people who inject drugs now and into the future would be the key to maximising results, according to two studies published in the same issue of the MJA.

Currently, few people with HCV who inject drugs receive antiviral treatment, but according to mathematical modelling, even modest rates of treatment using conventional antiviral regimens (a combination of interferon and ribavirin) for those infected could halve HCV infection prevalence over 30 years. (4)

Annual treatment rates of just 13, 17 or 25 per 1000 people with HCV infection who inject drugs would reduce prevalence by 20%, 30% and 50% respectively.

A real-world clinical study of HCV-infected people from 24 HCV clinics across Australia, also found substantial benefits of treating people who inject drugs. (5)

Researchers found a sustained virological response by intention to treat in 60% of patients and a resulting improvement in biochemical markers of liver disease, despite the inclusion of patients with a broad range of comorbidities including alcohol misuse, psychiatric illness and injecting drug use.

“By including such patients, we were able to show that drug- and alcohol-related factors and psychiatric illness were not significant impediments to successful treatment outcomes”, they wrote.

– Amanda Bryan

1. MJA 2012; 196: 629-632
2. Centers for Disease Control and Prevention: Press release 18 May 2012
3. MJA 2012; 196: 614
4. MJA 2012; 196: 638-641
5. MJA 2012; 196: 633-637

Posted 4 June 2012