Experts Call for End of Restricted Access to Hepatitis C Antivirals for Drug Users

In a gathering at the International Symposium on Hepatitis Care in Substance Users, global experts have called for the removal of restrictions on drug users that prevents them from gaining access to new hepatitis C virus (HCV) treatments and cures.

HCV affects about 64 to 103 million people worldwide, and kills approximately 700,000 per year. In most high income countries, 80% of new infections are among injection drug users.

Despite this, drug users have faced widespread exclusion from new HCV therapies.

Some of the reasons this group is excluded from treatment includes the price of new medications, fears of reinfection, concerns over efficacy, and fears of poor adherence. However, international research has debunked these myths, and the group of experts concluded that as long as these restrictions exist, the goal of eliminating hepatitis C will remain out of reach.

“The science is clear,” said Jason Grebely, president of the International Network of Hepatitis C in Substance Users (INHSU). “We now need to focus on overcoming barriers to access, and harness latest research to implement programs that work. To delay further is unethical and undermines public health.”

In recent news, the world’s largest study of new HCV curative therapies, called the C-EDGE CO-STAR clinical trial, revealed that illicit drug use prior to and during hepatitis C therapy had no impact on the efficacy of treatment, and that reinfection was as low as 4%. Furthermore, the trial showed that adherence to treatment was excellent, despite these concerns.

In another study that used mathematical modeling to examine settings in Australia, Canada, and Scotland, the findings revealed that a 3- to 5-fold increase in treatment uptake among injectable drug users could halve HCV prevalence in 15 years. Meanwhile, other studies, modeled on individuals who inject drugs in France and the UK, concluded that a realistic treatment scale-up could achieve a 15% to 50% reduction in chronic HCV prevalence within a decade.

Additional studies have found that treating moderate-to-mild hepatitis C drug users with new therapies is cost effective in a majority of settings, compared with delaying treatment until the development of cirrhosis.

“We strongly recommend that all restrictions on access to new hepatitis C treatments based on drug or alcohol use or opioid substitution treatment be removed,” said Olav Dalgard, chair of the INSHU 2016 Symposium. “There is no good ethical or health based evidence for such discriminations. Nor do the restrictions make clinical, public health or health economic sense.”

Thus far, several countries have introduced HCV elimination programs, with Australia, Iceland, and France offering unrestricted access.

“Countries such as Australia and France have taken the lead in adopting evidence-based policies that save lives,” Dalgard said. “Now it’s time for other countries, including the US and Norway, to follow their lead and allow all patients with chronic hepatitis C to be treated with the new drugs.”

The authors concluded that by opening up access to treatment for this disease, it can only prove to be beneficial in combating the HCV epidemic.

“Providing treatment to people who inject drugs, integrated with harm reduction programs and linkage to care, is the key to hepatitis C program success,” said researcher Jeffrey Lazarus. “And our experience in Copenhagen shows this can work. Such efforts need to be initiated and scaled up globally.”

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