UNITAID can address HCV/HIV co-infection

Abstract

In the fi rst days of March, the governing body of UNITAID, the organisation fi nanced mainly through a levy on air tickets, will decide on a new 4-year strategy. A 5-year evaluation praised UNITAID’s success ful “market impact” model for improving access to HIV, tuberculosis, and malaria products through lower ing prices, improving supply, or introducing new products. We believe UNITAID’s new strategy should also include tackling a prevalent and serious, but curable, HIV co-morbidity: hepatitis C virus (HCV) infection. Worldwide, an estimated 4–5 million people are HCV/HIV co-infected. HCV is a leading cause of death in people with HIV in western settings and causes substantial morbidity and mortality in the many co-infected people in lowincome and middle-income countries. HIV acceler ates HCV progression, and HCV co-infection is associated with higher rates of all-cause, liver-related, and AIDS-related death. Access to treatment with pegylated interferon alfa and ribavirin is extremely limited in low-resource settings owing to the regimen’s complexity, duration (48 weeks), and cost (up to US$30 000). Outcomes in low-income and middleincome countries are similar to those reported in high-income countries; sustained virological response for co-infection can be as high as 60% depending on genotype. Fortunately, the HCV drug pipeline is extremely promising, thanks to profi table markets in high-income countries. New, more tolerable, all-oral regimens are showing remarkable cure rates in clinical trials. These shorter regimens might no longer require genotyping or complex monitoring. Simpler, better treatment is key for resource poor settings—but new drugs must become available and aff ordable. UNITAID is already committed to HIV co-morbidities; its expertise and track record in lowering antiretroviral prices for developing countries sh ould now be applied to HCV. UNITAID can guarantee and pool initial drug demand, negotiate price reductions, and facilitate generic competition as appropriate and feasible, support quality assurance through WHO’s Pre-Qualifi cation Programme, introduce simpler diagnostics when becoming available, and generate demand forecasts, as countries start increasing access to HCV treatment. UNITAID’s unique role is to lower prices; organisations such as the Global Fund to fi ght AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief should help in scaling up treatment. Inclusion of HCV/HIV co-infection in UNITAID’s new strategy would have a dramatic eff ect on health and keep UNITAID at the forefront of market impact interventions.