Although there has been little limelight left to share amongst the other BBVs, it would be a fatal oversight to underestimate the impact of viral hepatitis. In fact, 2016 data shows that viral hepatitis is a leading cause of death globally with a death toll exceeding that of HIV (1.3 million deaths), tuberculosis (1.2 million deaths) and malaria (0.5 million deaths) ⁽³⁾

Focusing on hepatitis C (hep C) specifically, the most recent national estimates suggest that 214, 000 individuals are chronically infected in the UK alone – which is even more alarming when you consider that chronic hep C infection is: ^(1-2)

• The second most common cause of liver transplant in the UK ⁽⁴⁾
• A risk factor for developing liver failure or liver cancer ⁽⁵⁾
• In England, only 35% of adults diagnosed with primary liver cancer will survive for 1 year or more after diagnosis ⁽⁶⁾

So it should come as no surprise that we need to act.

Earlier this year (2016), The World Health Organization (WHO) finalised a set of global viral hepatitis elimination targets, including a 90% reduction in incidence (new infections) and a 65% reduction in viral hepatitis-related deaths by 2030 compared with 2015. ⁽³⁾ While these targets may seem ambitious, there is hope that they will be achievable.

Typically, older treatments for hep C were less effective, lasted much longer and had significant side-effects compared to newer treatments (direct-acting antivirals); however, it is now possible to cure over 90% of people infected with hep C within 3-6 months. ^(7-8) In addition, the side effects of newer treatments are usually mild.⁽⁷⁾

As the new era of hep C treatment takes hold, there is increasing focus on people who inject drugs (PWID) and the pivotal role they will play in achieving the targets set forth by WHO.  In 2011, it was reported that up to 67% of PWID worldwide are hep-C positive so treating and curing this population will have a huge impact on transmission rates, greatly reducing the global burden of hep C. ^(9-11)

In addition, there are case studies which suggest that treating hep C can be a huge personal achievement for PWID and it is speculated that this cure can have an enduring and positive influence on individual lives.

However, even though addiction is recognised as a chronic, relapsing medical condition there is still a level of stigma that all-too-often surrounds PWID. So there are three key things to remember when someone asks you ‘Why should we treat hep C in PWID?’:

1. Ongoing alcohol or drug use is not a barrier to successful treatment – hep C cure rates are as high in PWID as in the general population. ⁽¹²⁾
2. Reported rates of re-infection after successful hep C treatment, among high-risk patients including PWID, are low (approx. 1-8% annually) ⁽¹²⁾
3. Treating hep C positive PWID will be a fundamental step to reducing hep C transmission rates  and ultimately prevalence ^(10-11)

Although all cases for hep C treatment should be considered on a case-by-case basis, it is crucial that we work together as a community of professionals and friends to ensure that stigma does not stand in the way of PWID receiving the hep C treatment that they need – both for their own health and well-being, and for the good of the others worldwide.

For over a decade, every year in the UK more than 6, 000 people are newly diagnosed with HIV. In 2014, the year for which we have the most recent data, more than half of those patients were Men who have Sex with Men (MSM).

The mainstay of HIV prevention in this country has long focused on awareness, education, condom promotion and – more recently – “test and treat”, based on increasing evidence of Treatment as Prevention (TasP). This latter principle was confirmed last month when a large study reported that HIV positive patients with an undetectable viral load are uninfectious to their sexual partners. Hence the emphasis of the London HIV Prevention Programme public campaigns, known as “Do It London”, on promoting HIV testing and safer sex as important, combined methods to reduce the risk of viral transmission.

Another major breakthrough in recent years has been the discovery of the efficacy of Pre-Exposure Prophylaxis (PrEP): the provision of antiretroviral medication to confirmed HIV negative people at high risk of exposure to HIV. This drug called Truvada (200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate) is manufactured by Gilead Sciences and has long been used to treat HIV positive patients.

Numerous trials across the world have demonstrated Truvada to be highly effective at preventing HIV transmission, representing a huge breakthrough in HIV science, and it is now prescribed in the USA, France, Canada and Israel for MSM at high risk of HIV infection. In the UK, the PROUD study revealed an extremely high rate of effectiveness in preventing HIV transmission for gay men and, earlier this year, the European Medicines Agency changed and extended the licence for Truvada to be used as a preventative drug. Yet, in the UK, it remains unavailable on the NHS; some patients are now buying versions of the drug online, from unlicensed manufacturers abroad.

Many commentators have publicly called Truvada a “game-changer” in the stubborn battle to prevent ongoing (and increasing) rates of HIV diagnoses, especially in MSM, whilst recognising that it must be used in combination with time-honoured prevention methods such as condoms and regular testing to be fully effective at population level – and to prevent other sexually transmitted infections. Yet PrEP has equally garnered front page media coverage and, over the summer, has become the subject of a pitched battle between HIV activists and NHS England.

On one hand, the science is clear: PrEP is a new, powerful addition to our “menu” of preventative options. That is especially true for some gay men who, for various reasons, find consistent condom use difficult and for whom regular testing is not offering enough protection. However, as with many new medications, the battle over cost – and who is responsible for bearing that cost (about £400 per month for the current drug, although it comes off patent in 2018) – has been played out in both the public domain and in the courts, with increasingly inflammatory rhetoric.

In August 2016, the High Court rejected NHS England’s contention that it was not responsible for commissioning PrEP, although (at the time of writing) NHS England is appealing that Judicial Review. Meanwhile, media coverage of the court case revealed something deeper about British attitudes towards sex, HIV and gay men. This was arguably triggered by NHS England’s press release about the case, which used unhelpful, simplistic language to describe the complexity of PrEP use. Referring to ‘men who have high risk condomless sex with multiple male partners’, it failed to recognise that, for most MSM, PrEP would likely be used either intermittently or for relatively short periods of time, such as at the end of a relationship, or when having sex with a new partner before confirming their HIV status within a testing window period, or especially in a serodiscordant relationship before confirmation of the HIV positive partner’s undetectable viral load.

Perhaps unsurprisingly, the “moralistic” line was taken up by some sections of the British press, which ignored the weight of medical evidence (and the widespread cross-party political support) and sought to blame gay men for their own sexual behaviour and HIV risk, echoing the media coverage of the mid 1980s when the victims of AIDS were often blamed for bringing the illness on themselves. The Daily Mail called Truvada a “promiscuity pill”, accusing the judge of “a skewed set of values” and contending that the NHS should “fight back” against a drug that, it claimed, would deny funding to treat other specialist conditions whilst causing “immoral behaviour”.

Much of this commentary ignored the life-changing health benefits of PrEP in favour of a kind of moral panic that pitted other illnesses against HIV prevention and stereotyped gay men, despite numerous experts insisting the drugs were regarded as a welcome game-changer, but not a magic cure.

At the time of writing, NHS England is appealing the Judicial Review on the grounds that local authorities have the legal responsibility to commission services to “prevent” HIV whilst, it argues, its own responsibilities are limited to treating those already assumed to be infected. This principle is contested on numerous grounds – including the complicated wording of the Health and Social Care Act 2012 which made councils responsible for public health, but left HIV treatment in the hands of the NHS – and supported by the fact that NHS England has long accepted the principle that it is responsible to fund the drugs used for Post-Exposure Prophylaxis (PEP) for HIV.

Meanwhile, NHS England is running a public consultation (closing 23 September) on PrEP and has set out its plans if the appeal fails. Were it to be provided, PrEP would be funded from the NHS England Specialist Commissioning budget – currently over £15bn per year. But with almost 150 different services competing for that budget, the decision will be a difficult one for NHS commissioners and is symptomatic of the pressures placed on the NHS by highly effective – but expensive – drugs.

The battle against HIV continues, which is why the London HIV Prevention Programme – funded by all 33 local authorities – will continue to educate the public about HIV, promote testing and safer sex, address ongoing HIV-related stigma and get the right information to those who need it most. Adding PrEP to that mix would arm us with a hugely effective tool to turn around this growing and intractable epidemic thirty-five years since it first began.

Paul Steinberg, Lead Commissioner, London HIV Prevention Programme

To hear more from Paul, register to attend HPE LIVE, the unmissable national event for secondary care pharmacists.

It may be summer in Europe and the rest of the Northern Hemisphere but it’s winter in Australia which means it’s the perfect time to roll out the CORE programme.  CORE – Hand in Hand in Heart Failure is a global free CME accredited educational programme which brings members of the multidisciplinary team together to learn in small groups about best practices in the diagnosis, treatment and management of heart failure.

Heart failure has a high incidence in both developed and developing companies and thus has an impact on both society and patients.  CORE aims to educated health care professionals in hopes of improving patient care.

Over 20 nationally renowned health care professionals, including cardiologists, general practitioners and specialist nurses from all over Australia came together to learn about the unique CORE programme with its tailored, small group education programme.  They will in turn conduct CORE education meetings throughout Australia over the next six months.  CORE will provide category 2 CPD points for general practitioners and CME credits for nurses (cardiologists are charged with self-reporting of credits in Australia).

It’s estimated that 60+ CORE meetings will be held in Australia before the end of the year, providing the opportunity for many members of the multidisciplinary team to learn together.

CORE is supported by funding from Novartis Pharma AG. All educational content and materials are created by the CORE Steering Committee in collaboration with PCM Scientific, the medical education company acting as secretariat. The financial supporter has had no involvement in the creation or development of the educational content.

For more information about CORE, click here.

Over 300 healthcare professionals from around the world met in Bristol, UK, at the 14th annualImproving Outcomes in the Treatment of Opioid Dependence (IOTOD) for 3 days of inspirational and interactive education.

Organised by PCM Scientific, this 3-day CME-accredited conference is a flagship meeting in the field of addictions therapy, bringing together healthcare professionals from around the globe to learn and commit to best practices to benefit the lives of patients.

Sharon Walsh, Professor of Behavioral Science and Psychiatry Centre on Drug and Alcohol Research, University of Kentucky, US, and John Marsden, Professor of Addiction Psychology, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK, chaired the 3-day conference.

Delegates participated in multiple sessions including 2 workshops:  Saving Lives:  Preventing Opioid Overdose Chaired by Professor Sir John Strang, Director, National Addiction Centre, King’s College London, UK, and Hepatitis C Virus (HCV):  Changing Landscapes in Opioid Dependence Chaired by Mr. Charles Gore, Chief Executive of the Hepatitis C Trust London, UK. These two workshops sparked hundreds of questions and comments, and encouraged delegates to reflect and submit their own personal commitments to make changes in their daily practice.

The latter workshop will also be available on our IOTOD website as a CME-accredited interactive webcast, allowing those addiction specialists unable to attend to benefit from this innovative education.

High regard for the event is evident from delegate responses:

“…thank you yet again for a great conference and a perfect 3 days of learning…”

“I have the utmost confidence that some of the information I will be passing onto my colleagues will go to improve the lives of the service users we help and guide on a daily basis.”

“…a memorable conference for all the right reasons.”

The 15th annual IOTOD meeting is scheduled for the 22nd–24th March 2017 in Budapest, Hungary.  Registration will open soon.  To find the full funding statement for the 2016 IOTOD meeting, pleaseclick here.