June 12, 2017
Earlier this year, I had the opportunity to join colleagues at the Health Resources and Services Administration's (HRSA) HIV/AIDS Bureau (HAB) and an invited group of clinical experts for a scientific consultation on expanding hepatitis C virus (HCV) treatment among people living with HIV. This issue is important because an estimated 1 in 5 of the 1.1 million people in the United States who are living with HIV are coinfected with HCV. People who are coinfected with HIV and HCV have worse health outcomes, including liver disease and increased risk of death.
The meeting was convened to identify successes, barriers, and costs associated with HCV care and treatment among people living with HIV (PLWH) as part of the "Study to Identify Barriers to HCV Treatment among People Living with HIV" being conducted by the George Washington University (GWU) Milken Institute School of Public Health. The purpose of the study is to understand and inform communication with stakeholders on barriers to addressing HCV among PLWH in primary care settings and the development of a strategic plan for addressing HCV screening, care, and treatment among PLWH. HRSA administers the Ryan White HIV/AIDS Program (RWHAP), which serves over 500,000 PLWH in the United States, including at least 100,000 coinfected with HCV. Curing HCV among people in the RWHAP could have significant benefits for the individual clients who are cured and further expand the capacity of providers and clinics to diagnose and successfully treat HCV among all the patients they serve.
Improving viral hepatitis treatment among persons living with HIV is among the strategies prioritized in both the National HIV/AIDS Strategy and National Viral Hepatitis Action Plan, 2017-2020. The national goals of 1) increasing access to care and improving health outcomes for people living with HIV and 2) reducing deaths and improving the health of people living with viral hepatitis are supported by these efforts. The recent availability of highly-effective direct-acting antiviral (DAA) therapies that can cure HCV in the majority of people who take them -- including people living with HIV -- offers an important opportunity to substantially reduce this common coinfection and further efforts to achieve these national goals.
This study, along with another HAB initiative, "Jurisdictional Approaches to Curing Hepatitis C among HIV/HCV Coinfected People of Color" will help to develop sustainable systems of care that effectively screen, treat, and cure HCV in those with coinfection. The findings will also inform future efforts to eliminate HCV coinfection among PLWH. Among the important insights that arose at the meeting were:
The meeting reflected the optimism among many that we can now leverage new HCV treatments and our healthcare delivery system to help reach our national goals by reducing, and perhaps even eliminating, one of the most common coinfections that represents a significant threat to the health and survival of PLWH in the United States.
Author's note: This project is supported in part by the Secretary's Minority AIDS Initiative Fund (SMAIF) which supports a wide range of activities that are designed to reduce new HIV infections, improve HIV-related health outcomes, and reduce HIV-related health disparities in racial and ethnic minority communities.
Corinna Dan, R.N., M.P.H., is viral hepatitis policy advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.
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