Hepatitis C Treatment: Optional or Essential?

From the Director

February 2010—Among people in Asia who acquired HIV through injection drug use, reports indicate that between 50 and more than 90 percent are coinfected with hepatitis C. Given that injection drug use is a major driver of the HIV epidemic in Asia, the lack of hepatitis treatment access for patients is a growing medical problem.

The primary challenge for clinicians and patients dealing with hepatitis in low- and middle-income countries is the high cost of medicines. Current regional prices for a 48-week combination regimen of pegylated interferon and ribavirin—the standard treatment for hepatitis C—range from about US$7,000 in Taiwan to US$12,000 in India, costs that do not include laboratory monitoring.

In December 2009, the World Health Organization met to develop a strategic plan on harm reduction for drug users in Asia and the Pacific. Pointing to the model of successful global advocacy that made antiretroviral therapy feasible, advocates, experts, and government officials proposed a goal of universal access to both HIV and hepatitis C treatments.

Researchers have clearly demonstrated high rates of treatment success for hepatitis C in Asian patients. But until the prices of anti-hepatitis C medicines come down, this success will only be possible for some Asians with HIV.

As people with HIV age, they are increasingly confronting chronic illnesses such as heart disease and cancers—often at higher rates than people without HIV. In this issue of the TREAT Asia Report, we begin a year-long series on HIV and cancer—an urgent and under-researched arena that TREAT Asia is actively addressing.

This series will describe the scientific challenges faced by an innovative range of cancer research efforts facilitated by TREAT Asia and made possible through the US National Institutes of Health and its International Epidemiologic Databases to Evaluate AIDS. As the stories illustrate, the HIV care and treatment landscape is becoming increasingly complex and will require that we look beyond antiretroviral therapy alone to provide comprehensive care to people living with HIV.

Annette Sohn, M.D.
Director, TREAT Asia