Cheap, imported generic hepatitis C drugs work well
A major conference on hepatitis treatment heard lots more good news about the new drugs for hepatitis C. For example, a single pill combining sofosbuvir with the new drug velpatasvir cured 95% of people living with hepatitis C and HIV co-infection. Results were similar regardless of hepatitis C genotype (1 to 4), the presence or absence of cirrhosis, and whether people had taken hepatitis treatment before or not.
But how many people in the UK will be able to access this new medicine and others like it? The situation is better in Scotland, but NHS England’s guidelines are so restrictive that the new generation of hepatitis C drugs are often only available to people who are already seriously ill with hepatitis C.
Faced with situations like this, individuals around the world have turned in desperation to the FixHepC buyer’s club in order to purchase their own hepatitis C medications. Whereas the NHS is legally obliged to purchase the branded, patent-protected versions of the medications which may cost £35,000 for a 12-week course, FixHepC helps people import generic versions of the medications, which cost far less – around £1000 a course.
They are manufactured by reputable companies in India, primarily for sale in Asian and African countries where the patents do not apply. It is legal for individuals to import small quantities of these generic medications into the UK and other countries, for their personal use only.
(An increasing number of people are importing medication for PrEP in the same way.)
But is treatment with imported generic medications safe and effective? Many people will have concerns about whether the imported medications are genuine.
In order to answer these questions, doctors monitored the results of a few hundred people obtaining drugs through FixHepC. Those taking part came from countries all around the world and were most frequently treated with sofosbuvir & ledipasvir or sofosbuvir & daclatasvir. Genotypes 1 and 3 predominated.
The study presented preliminary data on sustained virological response four weeks after the completion of treatment, also known as SVR4. This was achieved by 94.4% participants, a response rate which matches that seen in clinical trials of the branded, patent-protected products which cost 35 times as much.
If you are thinking of getting your hepatitis C treated in this way, it’s very important to identify a reputable supplier for the medication and to be monitored by a doctor specialised in hepatitis. For more details, visit www.FixHepC.com.au
Dropping out of care
UK researchers are trying to understand more about the needs of people who have missed appointments at their HIV clinic. People who are unable to attend regularly or who drop out of medical care tend to do worse in the long run, so clinicians are keen to find ways to keep people engaged in care.
Comparing patients in London who did not attend regularly with those who did, the researchers found that a wide range of social and health factors were associated with missing appointments. Although there were some points in common, the circumstances which make engaging with medical care difficult are specific to each individual.
Women who had childcare responsibilities were more likely to miss appointments. People who did not always have enough money for their daily needs also had difficulties.
People who had symptoms of depression, or who do not feel in control of their lives, were more likely to miss appointments. Individuals reporting problems with memory or concentration sometimes forgot to attend. People using recreational drugs also missed appointments.
Stigma also emerged as a barrier. People who said that they did not want to think about having HIV and people who said they did not want to be seen at an HIV clinic were especially likely to have long gaps in their attendance.
Repeat hepatitis C infections in gay men
Significant numbers of gay men living with HIV are acquiring hepatitis C, having it treated and cleared, and then being infected with hepatitis C for a second or third time. The research is based on around 600 men treated for hepatitis C in London, Paris, Vienna and three German cities.
During three years of follow-up, one quarter of the men had a repeat hepatitis C infection. Some men had several repeat infections.
The researchers believe that current prevention strategies are failing. They also say that individuals who have been successfully treated should be tested for hepatitis C again every 3 to 6 months – in case they have acquired hepatitis C again.
There’s more information on this issue in NAM’s illustrated leaflets How hepatitis C is passed on and How hepatitis C is passed on during sex.
Unpleasant sexually transmitted infection: shigellosis
Another nasty infection which can be passed on during sex and which HIV-positive gay men are especially vulnerable to is shigellosis. This is a bacterial infection that can cause severe dysentery. Historically, cases in the UK have been associated with travel to low-income countries with poor hygiene. It is highly infectious and has very unpleasant symptoms, including fever, severe bloody diarrhoea and abdominal cramps.
But in recent years there have been more cases of shigellosis in people who have not recently been abroad than in people who have probably acquired it during travel. Moreover one third of people with shigellosis and no recent foreign travel are HIV-positive gay men.
Rimming and fisting are probably the riskiest activities (the bacteria may be present in faeces). Many of the men who have had shigellosis infection have had large numbers of sexual partners and were involved in the chemsex scene.
Shigellosis can cause stomach pain and watery diarrhoea. More serious cases can involve severe diarrhoea, which can contain blood or mucus, stomach cramps, nausea, vomiting and a fever.
If you have these kind of gastrointestinal problems and you could have acquired an infection during sex, make sure you are seen by a doctor who is familiar with shigellosis. The doctor also needs to know about your sexual practices – otherwise they may not check for shigellosis. Doctors in sexual health and HIV clinics are more likely to be aware of this infection being sexually transmitted than GPs.
For more information on this topic, read NAM’s factsheet Shigellosis.
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