Hepatology

Steep decline in HCV attributed to DAAs


Hepatitis C rates have declined by a staggering 60% among people who inject drugs since direct acting antiviral (DAAs) cures were made available through the PBS in 2016, according to a report from the Kirby Institute at University of NSW, Sydney.

The latest annual study of 53 needle and syringe programs (NSPs) which included results from 2,742 people who inject drugs, found that the proportion with detectable HCV RNA (active infection) had declined significantly from 51% in 2015 to 20% in 2018 .

The reductions occurred as the number of eligible people who had received HCV treatment increased significantly, from 13% in 2014 to 55% in 2018.

Overall, the 2018 figures showed that in the population of people who inject drugs, 20% had active HCV infection, 25% had cleared infection and 55% were non-exposed.

Researchers from the Kirby Institute said the unprecedented reductions in active HCV infection were good news not just for people who had been cured, but also for reducing transmission. HCV antibody prevalence declined nationally from 54% in 2014 to 45% in 2018, they noted.

“Our results show that there are significantly less people living with hepatitis C, but also, that the risk of transmitting hepatitis C has more than halved since the introduction of the new treatments,” said Dr Jenny Iversen, lead author of the report.

Melanie Walker, CEO of the Australian Injecting and Illicit Drug Users League (AIVL), welcomed the results but said that achieving HCV elimination in Australia would also require Needle and Syringe Programs (NSPs) to be extended to include prisons, where shared needle use is still common and around 30% of inmates have active HCV infection.

“The new treatments are clearly already having a big impact, but the focus on priority populations and prevention, particularly for those in custodial settings, must now be enhanced if we are to achieve the elimination of hepatitis C in Australia,” she said.

However Mr Luke Grant, Assistant Commissioner with Corrective Services NSW, said prison officers would not accept the introduction of NSPs in jails due to of deeply-held fears that needle and syringes might be used as weapons to attack staff.

He added that the evidence for NSPs in prisons was not strong according to recent systematic reviews, and it would therefore be difficult to make  a strong case for implementing them when much stronger evidence existed for eliminating HCV with antiviral treatment programs.

“I don’t think you’ll sway the general psychological position of prison officers [on needle and syringe programs] with the status of the evidence as it is,” he told a UNSW seminar to mark World Hepatitis Day.

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