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Pre-Exposure Treatment for Hepatitis C?

The concept of pre-exposure prophylaxis to prevent HIV infection is well established. In an editorial in Hepatology, and Australian researcher proposes extending the concept to people at high risk for getting hepatitis C: HIV-infected men who have sex with men.

Pre-exposure prophylaxis (PrEP) works to prevent HIV infection. People at high-risk are being encouraged to take tenofovir (Truvada/Gilead) the antiviral that prevents infection.

Why not apply that concept to preventing hepatitis C virus (HCV) infection by giving those at risk direct-acting antivirals before they get HCV?

Writing in an editorial in Hepatology, Gregory Dore, PhD, of The Kirby Institute, University of New South Wales, Sydney, Australia, argues that men who have sex with men (MSM) and are HIV positive are likely to get HCV sooner or later. That also applies to people who inject drugs.

Using mathematical modeling, Dore cites a "pessimistic scenario," in which "the proportion of HIV-infected MSM engaging in high-risk sexual behaviors increase to above 20% " and even treating all new cases of HCV annually would not stop the spread of the virus.

Ongoing high-risk behavior such as unsafe sex and injection drug use "has the potential to produce high rates of both initial HCV infection and HCV reinfection following successful HCV treatment" he writes.

Better to eliminate the virus before it takes hold, he says.

Drug price is apparently not an access issue because the Australian government subsidizes the cost of direct acting antiviral (DAA) therapy for HCV without restrictions such as having advanced liver disease or abstaining from drug and alcohol use.

In the first four months of such new access to DAAs, 10% of people with chronic HCV have started treatment.

"The Australian situation provides and example of an ideal setting for treatment-as-therapy evaluation," Dore says.

Dore is a consultant who has received research grants from Abbvie, Bristol Myers Squibb, Gilead, Merck, and Janssen.

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