A Perspective on Bloodborne Viruses

Photo right: Dr Krispin Hajkowicz presenting on HIV

MONA CHONG AND SUZANNE O'CALLAGHAN

Dr Desdemona Chong is Clinical Psychologist with the Queensland Haemophilia Centre, Royal Brisbane & Women’s Hospital

Suzanne O’Callaghan is Policy Research and Education Manager, Haemophilia Foundation Australia

Hepatitis C

Chair: Suzanne O’Callaghan
Hepatitis C: medical issues for PWBD and treatment, incl direct acting antivirals – A/Prof Simone Strasser
Personal story of a person living with HCV – Dave, QLD
Hepatitis C progression – barriers to monitoring liver health and treatment – Mary Fenech and Beryl Zeissink

Simone Strasser and her colleagues have had a long history of treating people with bleeding disorders and hepatitis C at the Royal Prince Alfred Hospital, Sydney, and she presented an optimistic picture for new treatments available for people with bleeding disorders and hepatitis C. The recent clinical trials of new direct acting antiviral (DAA) treatments that she presented, such as Harvoni® and Viekira Pak®, demonstrated very high cure rates with few side effects and greater tolerability. These treatments are generally in tablet form over a much shorter time-span than previous treatments, eg 12-24 weeks, leading to a much higher quality of life than interferon-based treatments. This means people can continue with their daily routine and work while receiving treatment. While these treatments are not yet available on the Pharmaceutical Benefits Scheme, the expectation is that they will be available next year.

A major take home message was the importance of keeping up with liver health checks. These can show whether liver disease is progressing – she gave examples of her patients who had developed cirrhosis even though they felt well – and the hepatitis specialist can then quickly investigate treatment options. Liver cancer caught early can be treated readily; and a liver transplant can also be considered if necessary. A liver health check is also a first step in assessment for hepatitis C treatment, and it is important to have completed this step as soon as possible to be considered for the new treatments once they are available. Fibroscans are now widely available and are used in a non-invasive, painless and short procedure to measure liver stiffness and gauge the level of liver disease.

In the second half of the session Dave, a community member with VWD and hepatitis C, and Mary Fenech, his hepatitis nurse, and Beryl Zeissink, his haemophilia nurse, discussed their approach to his recent hepatitis C DAA treatment through a compassionate access scheme. They highlighted the importance of staying in close contact with the clinic during treatment as individuals need to be monitored and have regular blood tests. Dave explained how straightforward and reassuring he found this, particularly as his treatment was easy to take and caused few side-effects. Mary Fenech pointed out that individuals who had developed cirrhosis prior to treatment would require six-monthly ultrasound liver scans post-treatment to continue to check for changes to the liver.

All in all, it was an uplifting and exciting session with a very hopeful message for people with bleeding disorders and hepatitis C.

HIV

Chair: Leonie Mudge
The legacy of HIV for the bleeding disorders community – Leonie Mudge
HIV – An update on treatment and the burden of co-morbidities, including hepatitis C virus co-infection – Dr Krispin Hajkowicz
Ageing/disability, resilience and HIV – psychosocial issues – Lynne Heyes

Suzanne O'Callaghan

Leonie Mudge commenced the session with an acknowledgement of the impact of HIV on the bleeding disorders community since it was first diagnosed in the mid-1980s and its ongoing legacy, both for those who live with HIV and those who lost family members or friends to the epidemic.

Today the situation for a person with a bleeding disorder and HIV is very different. Krispin Hajkowicz, an infectious diseases physician who provides HIV care at the Royal Brisbane & Women’s Hospital, gave a stimulating update on the current state of play with HIV.

Treatment for HIV now is usually a single-tablet regimen combining drugs from 3 classes, such as Atripla®, and the newer Stribild®, Eviplera® and Triumeq®, enabling people with HIV to take one tablet a day. The newer treatments are potent and well-tolerated and it is unusual to see drug failure in this group. The newest class of HIV drugs being trialled – and possibly the last new class to be approved in the foreseeable future – are maturation inhibitors that interfere with the final step of HIV maturation. No other class of drugs has this kind of action.

With many people with HIV very stable now, the question has shifted to how much monitoring is required. Krispin Hajkowicz noted that while a viral load test is valuable and should be undertaken every 6 months, a CD4 count test is now much less important if a person is stable.

Lifestyle issues are still high on the health list, with diabetes being a common complication and smoking the most significant health risk in HIV.

For people with bleeding disorders and HIV, managing HCV co-infection is high on the agenda. Some community members have already had successful treatment for their hepatitis C, but in HIV/HCV co-infection the success rates for interferon-based treatments have been very low. He explained that the new DAA treatments are good news for people who are co-infected, with outcomes similar to those who only have hepatitis C, and that drug-drug interactions are not a major issue as they can be overcome with good choices. He referred interested delegates to the CEASE study at the Australian Kirby Institute, which is aimed at eliminating co-infection.

While he was very hopeful about the potential of the new DAA treatments to cure his co-infected patients, he also remarked on the frustration of having bleeding disorders patients with advanced disease falling through the cracks of special access because their co-morbidities and liver disease complications make them ineligible. HFA is also aware of this issue; it is a solemn reminder of the need for access to the new hepatitis C treatments in Australia without delay.

References
The Kirby Institute for Infection and Immunity in Society, University of NSW. CEASE: Control and Elimination within AuStralia of HEpatitis C from people living with HIV