According to a presentation at the 2015 Conference of Retroviruses and Opportunistic Infections ( CROI), HIV and Hep C co-infected patients who delay treatment, remain at risk of liver failure , liver cancer and death, even after they have been cured. Furthermore, the longer treatment is delayed, the worse the outcome. This is a very strong argument for early treatment and again this should be a wake up call for NHS England who won’t approve treatment for people unless they have advanced disease.
We know that over many years infection with the Hepatitis C virus can lead to advanced liver disease, including cirrhosis ( scarring), liver cancer and liver failure. In people co-infected with HIV and Hep C this progression happens faster, so there is an even more urgent need to treat these patients. Successful Hepatitis C treatment reduces but doesn’t completely eliminate the risk of further progression, altogether.
In the past, treatment was often delayed because of the severe side effects of interferon and the low success rate of treatment. However we now have highly effective direct acting antivirals ( DAA) that can cure Hep C in most people, even in co-infected patients. The problem is the cost and NHS England have only agreed to treatment for those patients with advanced disease. This strategy is likely to cost lives in the end and we should be putting pressure on them to approve treatment for everyone infected regardless of the stage of the disease. The evidence of the benefit of this is clear.
The researchers commented that timely treatment of Hepatitis C infection is important , as patients can still progress to end stage liver disease after clearing Hepatitis C, if the treatment is delayed until they are in the later stages of liver disease. The evidence from this research will be used to ease discussions with governments as it clearly shows the benefit of early treatment. Hopefully this will lead to early treatment for all co-infected patients.