Hepatitis C treatment as prevention: Could it work? Professor Greg Dore Kirby Institute, UNSW Australia; & St Vincent’s Hospital, Sydney

Eradication versus Elimination Eradication: complete and permanent worldwide reduction to zero new cases of an infectious disease through deliberate efforts, with no further control measures required (e.g. smallpox). Elimination: reduction of the incidence of infection caused by a specific agent to zero in a defined geographical area as a result of deliberate efforts, but requires the presence of continued measures to prevent re-establishment of transmission (e.g. measles, poliomyelitis)

We have modelling data to show it can work Martin N et al. Hepatology 2013;58:1598-1609

HCV treatment as prevention for PWID Martin N et al. Hepatology 2013;58:1598-1609

HCV treatment as prevention: Edinburgh IFN-free DAAs Martin N et al. Hepatology 2013;58:1598-1609

HCV treatment as prevention: Melbourne IFN-free DAAs Martin N et al. Hepatology 2013;58:1598-1609

HCV treatment as prevention: Vancouver IFN-free DAAs Martin N et al. Hepatology 2013;58:1598-1609

HCV screening and treatment uptake low Dore GJ et al, J Viral Hep 2014

We need “perfectovir” Key attributes High efficacy (>90%) Minimal toxicity Once daily dosing Pangenotypic Short duration (4-6 weeks) Low cost

HCV prevalence and genotype distribution Hajarizadeh B, Grebely J, Dore GJ. Nat Rev Gastroenterol Hepatol 2013

Sofosbuvir/GS-5816 Treatment naïve, F0-3, 12 weeks SVR12 % Everson GT, et al. ILC2014

We need enhancement of harm-reduction Why? Combination HCV prevention strategies will be more effective Engagement point for HCV testing, referral, and treatment Required for HIV prevention

Global harm reduction strategies Only 41% (n=82) of countries had implemented NSPs Mathers B, et al. Lancet 2010

Global harm reduction strategies Only 35% (n=70) of countries had implemented OST Mathers B, et al. Lancet 2010

We need evaluation in different settings Potential settings Community-based PWID Prisons HIV+ MSM Perinatal

HCV treatment as prevention for PWID Core principles Individual health benefit needs to be central Community partnerships in development and implementation Should enhance rather than undermine harm-reduction Impact on risk behaviour should be component of evaluation Access to retreatment for individuals with reinfection

Acknowledgements Kirby Institute, UNSW Australia Jason Grebely Gail Matthews Tanya Applegate Pip Marks Marianne Byrne Tony Butler National Collaborators Andrew Lloyd Margaret Hellard International Collaborators Natasha Martin Peter Vickerman