Hepatitis C coinfection can be eliminated in people living
with HIV in the United Kingdom by 2021, the British HIV Association said today.

“The
UK can be the first country to achieve microelimination of hepatitis C in those
living with HIV, well ahead of WHO targets. We should seize this opportunity,”
BHIVA said in a statement released today.

Speaking
at last week’s British HIV Association Hepatology Highlights Meeting, Professor
Graham Cooke of Imperial College, London, said that breaking down World Health
Organization targets for hepatitis C elimination into microelimination targets
for individual populations such as people living with HIV would help to drive
progress towards the larger target of treating 80% of those eligible for
direct-acting antiviral treatment by 2030.

Public
Health England estimated that approximately 3300 people with HIV were also
living with hepatitis C coinfection in England at the beginning of 2016.
Approximately half were receiving care in London and around 15% in Birmingham
and Manchester. Since then, about half have been cured of hepatitis C, although
in some regions – including Tayside in Scotland and the North East of England – almost all
coinfected patients have already been cured.

BHIVA
said this week that it wants to see every person living with HIV and hepatitis
C assessed for direct-acting antiviral treatment by April 2019 and 80% cured by
that point. By April 2020 BHIVA wants to see 90% of hepatitis C infections
cured in people living with HIV and complete elimination the following year.

They
say that progress towards curing hepatitis C in people living with HIV has been
rapid over the past two years but reaching the last 20% of patients could be
harder.

“This is because services will have to treat
a small number of particularly vulnerable patients who struggle to make
appointments and take medicines. In the short term, many services are likely to
need additional staff and new ways of delivering care to ensure all those with
the virus can be cured. Achieving this is likely to require plans tailored to
individuals being delivered in different settings across the UK.”

Further progress towards microelimination in
people living with HIV will also have an impact on new infections, as the
number of people able to transmit hepatitis C falls. Prof. Cooke told the BHIVA
meeting that preliminary evidence from the Netherlands and London shows that
the incidence of hepatitis C has fallen in recent years, although more evidence
is needed to set realistic targets for prevention.

He stressed that international networks among
men who have sex with men play an important role in the ongoing incidence of
hepatitis C in people living with HIV, and that an increasing proportion of new
diagnoses of hepatitis C are cases of reinfection.

BHIVA warns that policies which deny
treatment to newly-infected people until chronic infection has been
established, including in cases of reinfection after cure, have the potential
to undermine progress towards microelimination.

“We would urge all health commissioners to
ensure treatment continues to be available for all who need it to stop the epidemic
re-emerging in PLWHIV.”