Treatment Action Group (TAG) is seeking organizational sign-ons to the letter, below, which will be sent to the Board and Chair of UNITAID.
Recently, UNITAID issued a call for letters of intent (LOI) on market-based interventions to increase access to key treatment, diagnostic, and preventive commodities for HIV, TB and malaria. For the first time, the call for LOIs included the possibility of addressing hepatitis C virus (HCV) coinfection with HIV.
Our letter encourages UNTAID to prioritize and support interventions that address HCV coinfection, given the scope of the HCV pandemic and current lack of a global response.
Kindly send the organizational (not individual) sign-ons to firstname.lastname@example.org by Friday, October 4, 5:00 p.m. EST.
Karyn Kaplan, Director, International Hepatitis/HIV Policy & Advocacy
Treatment Action Group (TAG)
SIGN ON LETTER
We commend UNITAID for addressing viral hepatitis in its 2013-2016 Strategic Objectives. We are writing to underscore the need for a swift response to hepatitis C virus (HCV) coinfection from UNITAID; 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 non-existent). HIV increases the risk for, and rate of progression to liver cirrhosis., End-stage liver disease secondary to HCV coinfection is a leading cause of death among HIV-positive people who have access to antiretroviral therapy., In fact, HCV coinfection increases the risk of all-cause, AIDS-related and liver-related mortality.
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.,,,
From the HIV experience, we have learned that it is possible to scale up delivery of life-saving 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 2 exploratory analyses identified in the 2013-2016 Strategic Objectives:
- -Make affordable treatment regimens available for HIV/HCV co-infections
- -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.
 Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol. 2006;44(1 Suppl):S6-9.
 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.
 Hernandez MD, Sherman KE. Curr Opin HIV AIDS. 2011 Nov;6(6):478-82.
 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.
 van der Helm J, Geskus R, Sabin C, et al; CASCADE Collaboration in EuroCoord. Effect of HCV infection on cause-specific mortality after HIV seroconversion, before and after 1997. Gastroenterology. 2013 Apr;144(4):751-760.
 Hernando V, Perez-Cachafeiro S, Lewden C, et al; CoRIS.All-cause and liver-related mortality in HIV positive subjects compared to the general population: differences by HCV co-infection. J Hepatol. 2012 Oct;57(4):743-51.
 Uberti-Foppa C, De Bona A, Morsica G, et al. Pretreatment of chronic active hepatitis C in patients coinfected with HIV and hepatitis C virus reduces the hepatotoxicity associated with subsequent antiretroviral therapy. J Acquir Immune Defic Syndr. 2003 Jun 1;33(2):146-52.
 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.
 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.
 Berenguer J, Zamora FX, Diez C, et al; for the 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. Paper presented at: 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). September 10-13, 2013. Denver, Colorado. Abstract H-1527.