New drugs for hepatitis C (HCV) are a significant improvement on those that were previously available. But pharmaceutical companies are charging extremely high prices for them, which is forcing health services to make difficult choices about which patients should be prioritised to receive the new drugs. Only those people with the most advanced liver disease are able to get the new drugs. It can be difficult for people who are not yet very sick to get the treatment that could prevent their illness from getting any worse.

In this context, doctors need to prove that certain groups of patients should receive treatment more urgently than others. One way of doing this is to show the consequences of leaving people without treatment. A group of researchers therefore looked at the risk of death, because of liver disease, in almost 4000 European people who had both HIV and hepatitis C. These people hadn’t received hepatitis C treatment. The researchers looked at this risk according to the degree of damage that had already occurred to the liver – little or no damage; fibrosis (moderate scarring); or cirrhosis (more serious scarring). Every year, 1 in 100 people died of liver disease. But compared to people with little or no fibrosis, this risk was more than doubled in people with fibrosis. And the risk was six-times greater for people with cirrhosis.

The doctors therefore argue that any person living with HIV who has either fibrosis or cirrhosis should be prioritised for treatment with the new drugs. 

While this would limit treatment to a minority of patients, it would be less restrictive than current NHS England policies – the drugs only go to some people with cirrhosis, the more advanced form of scarring. The research also found that having a low CD4 count raised the risk of liver disease and death. HIV treatment improves liver-related outcomes, so anyone with HIV and hepatitis C co-infection should start HIV treatment as soon as possible, the researchers recommend.

The full article can be read here.