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

2. 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)

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

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

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

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

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

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

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

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

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

12. 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

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

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

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

16. 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

17. 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