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Letter Urging UNITAID to Prioritize HIV/HCV Coinfection

October 10, 2013

Dr. Philippe Douste-Blazy, Chair, Executive Board
UNITAID
c/o World Health Organization (WHO)
20, avenue Appia
CH-1211, Geneva 27
Switzerland

Dear Dr. Philippe Douste-Blazy and members of the Executive Board,

We commend UNITAID for addressing viral hepatitis in its 2013–2016 Strategic Objectives. We are writing to underscore the need for a swift response from UNITAID to hepatitis C virus (HCV) coinfection; delays will cost lives and impede scale-up when more effective and tolerable therapies are available.

HCV is a prevalent—and deadly—coinfection among people living with HIV/AIDS, especially people who inject drugs (PWID). An estimated 5 million people are HCV-coinfected (although surveillance data in many low- and middle-income countries [LMICs] are limited to nonexistent).[1] HIV increases the risk for, and rate of progression to, liver cirrhosis.[2],[3] End-stage liver disease secondary to HCV coinfection is a leading cause of death among HIV-positive people who have access to antiretroviral therapy.[4],[5] In fact, HCV coinfection increases the risk of all-cause AIDS-related and liver-related mortality.[6]

Hepatitis C is curable (an outcome known as sustained virological response, or SVR), regardless of HIV status. In HIV/HCV-coinfected people—even those with cirrhosis—SVR is associated with improved ART tolerability and decreased liver-related and AIDS-related illness and death.[7],[8],[9],[10]

From experience with HIV, we have learned that it is possible to scale up delivery of lifesaving treatment in LMICs. UNITAID has been instrumental in the continued success of HIV treatment scale-up in LMICs.

Given the upcoming HCV treatment revolution and the inevitable HCV-related death toll among untreated coinfected people in the coming years, we urge UNITAID to promptly provide full support for the two exploratory analyses identified in the 2013–2016 Strategic Objectives:

  • Make affordable treatment regimens available for HIV/HCV coinfections

  • Consolidate demand, and negotiate prices for key HCV diagnostics


We strongly believe that immediately addressing HCV coinfection will bolster UNITAID’s main priority. Interventions to facilitate access to HCV diagnostics and treatment must commence if we are to optimize HIV treatment outcomes for millions of people. We urge UNITAID to support high-quality proposals that address HIV/HCV coinfection without delay.

 Sincerely,

AA Bangladesh, Bangladesh

ABCD Health Services, USA

Aceso International for Women

ACT UP-Paris, France

Action S Impliquer Dans l Amour (S.I.D.A) Comores, Comores

ADHARA, Spain

African Community Advisory Board (AFROCAB)

AGEP'C NGO (ANTIHEPATITIS'C), Kazakhstan

Aid Organization (AO), Bangladesh

AIDS Action Baltimore, USA

AIDS Community Research Initiative of America, U.S.

Aids Fonds, The Netherlands

AIDS Foundation of Chicago, United States

AIDS Project Los Angeles, US

AIDS Services Foundation Orange County, USA

AIDS Treatment Activist Coalition, USA

ALCS (Association de Lutte Contre le Sida), Morocco

All-Russian Union of People Living with HIV/AIDS

amfAR, the Foundation for AIDS Research, United States

Andrey Rylkov Foundation for Health and Social Justice, Moscow, Russia 

Anex (Association for Prevention and Harm Reduction Programs Australia)

Asia Catalyst, USA

Asia Pacific Network of People Living with HIV/AIDS (APN+)

Asia Pacific Network of Sex Workers (APNSW)

Asian Network of People Who Use Drugs (ANPUD)

Associação SCARJoV, Angola

Association d'Assistance au DÈveloppement, Cameroon

Association of HIV Affected Women and Their Families DEMETRA, Lithuania

BLOSSOM TRUST, INDIA

Bolivian Network of People Living with HIV/AIDS (REDBOL), Bolivia

BOOM! HEALTH, United States

Boston Health Care for the Homeless Program, US

BUILDING CAPACITIES FOR BETTER HEALTH IN AFRICA, CAMEROON

BURUNDI NETWORKOF RELIGIOUS LEADERS LIVING WITH ORPERSONALLY AFFECTED BY HIV/AIDS, BURUNDI

CADIRE CAMEROON ASSOCIAATION, CAMEROON

Canadian HIV/AIDS Legal Network (CHALN)

Centre for Excellence for Research in AIDS (CERiA) - Malaysia

Chichetekelo Outreach Partners, Zambia

Citizen News Service – CNS, India

COMMUNICATION FOR DEVELOPMENT CENTRE, NIGERIA

Community HIV/AIDS Initiative Group, Kenya

Delhi Network of Positive People (DNP+), India

Dhading Plus, Nepal

East Europe & Central Asia Union of PLWHA

Egyptian Initiative for Personal Rights (EIPR)

ELIMU RESOURCES AND EDUCATIONAL CENTER, KENYA

Emmanuel Hospital Association (EHA), India

Estonian Network of PLWH, Estonia

Eurasian Harm Reduction Network (EHRN), Lithuania

European AIDS Treatment Group, Belgium

FIS (For Impacts In Social Health), Cameroon

Foro Español de Activistas en Tratamientos (FEAT) Spain

Fundación Huésped, Argentina

FUTURE WITHOUT AIDS (FWA) - Odessa

GAT - Grupo Português de Activistas sobre Tratamentos de VIH/SIDA

Georgian Harm Reduction Network (GHRN)

Global Coalition of Women Agaisnt AIDS in Uganda - GCOWAU

The Global Forum on MSM & HIV (MSMGF), USA

The Global Network of People Living with HIV (GNP+), Netherlands

The Global Network of Sex Work Projects (NSWP)

Harm Reduction Coalition, USA

HCMSG-The Hepatitis C Mentor and Support Group,Inc., USA

HCV ADVOCATE, United States

Health for All Association, Yemen

Health GAP (Global Access Project), USA

Hepatitis Education Project, United States

HIV i-Base, London

HIV/AIDS Law Project, USA

HIV/AIDS Patients Support Foindation, Georgia

Housing Works, USA

Independent Consulting Company MChJ “Community of PLHIV,” Uzbekistan

Indonesia AIDS Coalition, Indonesia

Indonesian Red Cross Branch Kapuas, Indonesia

Initiative for Medicines, Access & Knowledge (I-MAK)

Integrated Development in Focus, Ghana

International Centre for Science in Drug Policy

International Community of women living with HIV Eastern Africa, Uganda

International Gay and Lesbian Human Rights Commission, USA

International Network of People Who Use Drugs (INPUD)

International Treatment Preparedness Coalition (ITPC)

International Treatment Preparedness Coalition Latin American and Caribbean, ITPC LATCA

International Treatment Preparedness Coalition Middle East and North Africa, ITPC MENA

International Union Against Tuberculosis and Lung Disease, France

Kirovograd Regional Charity Organization "Open Heart", Ukraine

Lebanese Association for Early Childhood Development

Legal Development and Democracy PU - Azerbaijan

LIBRE DE VIH, Mexico

Mainline, the Netherlands

MAISHA YOUTH AGAINST AIDS, KENYA

Marvorid, Tajikistan

Men Against AIDS Youth Group, Kenya

Missouri Hepatitis C ALliance, USA

National Association of PLHA in Nepal (NAP+N)

National Coalition of PLHIV in India - (NCPI+), India

National Emergency Management Agency (NEMA) South-South Zonal Office, Nigeria

Network Of Maharashtra by People Living with HIV/AIDS - (NMP+), India

NGO "AGEP'C"(ANTIHEPATITIS'C), Kazakhstan

PeterCares House, US

Phoenix - Georgia

Phoenix PLUS – Russia

PILS (Prevention Information et Lutte contre le Sida), Mauritius

PKNI (Indonesian Drug User Network)

Positive Malaysian Treatment Access & Advocacy Group (MTAAG+)

Positive People Armenian Network

POSITIVE-GENERATION, Cameroon

Professionals For Humanity (PROFOH), Nigeria

Projecte dels NOMS-Hispanosida, Spain

Rainbow TB Forum, INDIA

Red Ribbon Foundation Inc., USA

Rehabilitation and Development Charity Center "Tanaziari," Georgia

S M L S TRUST, INDIA`

sairam health care charitable trust, India

SASO, Imphal - India 

Sewa Development Trust Sindh, Pakistan

Society Association HIV.LV, Republic of Latvia

Solthis, France

Spark of Hope – Ukraine

Tanzania Public Health Initiative, Tanzania

Tanzania Sisi Kwa Sisi Foundation (TSSF), Tanzania

Thai AIDS Treatment Action Group (TTAG), Thailand

The AIDS Support Organisation (TASO) Uganda, Uganda

transbantu association zambia, zambia

Treatment Action Group (TAG), U.S.A.

Treatment Education Network, USA

Urban Health Research Initiative of the BC Centre for Excellence in HIV/AIDS / University of British Columbia, Canada

Viet Nam National Tuberculosis control Program, Viet Nam

Vietnam Network of PLHIV (VNP+)

Voices Of Community Activists & Leaders (VOCAL-NY), USA

Vote For Health campaign

Whittier Rio Hondo AIDS Project, USA

With hope, Ukraine

Women and Harm Reduction International Network (WHRIN)

Women`s Health, HIV and AIDS Southern Africa – Zimbabwe

WOTE YOUTH DEVELOPMENT PROJECTS, KENYA

Yale Global Health Justice Partnership, USA

 


[1] Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol. 2006;44(1 Suppl):S6–9.

[2] Graham CS, Baden LR, Yu E, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001 Aug 15;33(4):562–9.

[3] Hernandez MD, Sherman KE. Curr Opin HIV AIDS. 2011 Nov;6(6):478–82.

[4] Weber R, Sabin CA, Friis-Møller N, et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006 Aug 14–28;166(15):1632–41.

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[8] Labarga P, Soriano V, Vispo ME, et al. Hepatotoxicity of antiretroviral drugs is reduced after successful treatment of chronic hepatitis C in HIV-infected patients. J Infect Dis. 2007 Sep 1;196(5):670–6.

[9] Berenguer J, Rodríguez E, Miralles P, et al.; GESIDA HIV/HCV Cohort Study Group. Sustained virological response to interferon plus ribavirin reduces non-liver-related mortality in patients coinfected with HIV and Hepatitis C virus. Clin Infect Dis. 2012 Sep;55(5):728–36.

[10] Berenguer J, Zamora FX, Diez C, et al.; GESIDA HIV/HCV Cohort Study Group. Hepatitis C eradication reduces liver decompensation, HIV progression, and death in HIV/HCV coinfected patients with non-advanced liver fibrosis (Abstract H-1527). Paper presented at: 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy; 2013 September 10–13; Denver, CO.