rates for hepatitis C can be achieved in Cameroon but the cost of treatment
remains out of reach for all but the wealthiest, findings from a demonstration
study of direct-acting antiviral therapy published in Tropical Medicine &
International Health show.
million people were estimated to be living with hepatitis C in sub-Saharan Africa
in 2015. Direct-acting antiviral treatment for hepatitis C remains out of reach
in most African countries due to a lack of national screening and treatment programmes,
lack of funding for treatment and unaffordable treatment.
tiered pricing and voluntary licensing agreements for lower-income and
lower-middle-income countries have cut prices of direct-acting antivirals, the
lack of national funding means that treatment must be funded by individuals.
Cameroon negotiated a price of $1203 for a 12-week course of sofosbuvir/ledipasvir
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
Foundation, University of Amsterdam and University of Yaoundé carried out the HepC-IMPACT
pilot study in Cameroon to investigate the feasibility of delivering direct-acting
antiviral treatment in clinics in Yaoundé, the capital city of Cameroon.
recruited 161 people with chronic hepatitis C diagnosed either due to
liver-related symptoms or after screening of a blood donation. The study excluded
people with decompensated cirrhosis or hepatocellular carcinoma, kidney disease
and people with chronic hepatitis B infection. People living with HIV were
eligible to join the study if they had an undetectable viral load on antiretroviral
therapy, CD4 cell count above 350 and no opportunistic infections.
participants had a median age of 61 years, 65% were women, 6% were HIV positive,
50% had genotype 4 infection, 35% genotype 1 infection and the remainder, genotype
2. Half had F0-F2 fibrosis, 18% F3 fibrosis and 31% F4 fibrosis (cirrhosis).
common risk factors for hepatitis C acquisition were a history of exposure to
collective vaccination (75%), scarring or tattoos (60%), invasive surgery (43%)
or traditional medical treatments with sharp objects (36%).
A total of 161
people began treatment with either sofosbuvir/ledipasvir (12 weeks) (94); sofosbuvir/ledipasvir/ribavirin
(12 weeks) (39); sofosbuvir/ribavirin (21); sofosbuvir/ledipasvir (24 weeks)
(6); or sofosbuvir/ledipasvir/ribavirin (16 weeks) (1).
One hundred and fifty eight people completed treatment and 152 (96%) achieved a sustained virological response,
including eleven patients who experienced interruptions to treatment. Seventy-five per cent of study
participants reported good adherence throughout their treatment course but
there was no significant difference in virological outcomes according to level
common adverse events were asthenia (12.0%), headache (11.4%) and dizziness
(18.9%). Three people died during treatment of co-morbidities not associated
with treatment. Study participants had a high burden of co-morbidities (42% had
hypertension and 18% had diabetes).
the six people who did not achieve a sustained virological response had
hepatitis C NS5A and NS5B mutations associated with resistance to ledipasvir
and sofosbuvir but the investigators say it is unclear if these mutations
contributed to treatment failure or if they were naturally occurring mutations circulating
in genotype 1 sub-types in Cameroon.
costs of treatment including laboratory tests was 1914 euros. The average drug
cost was 477 euros. Participants in this study paid 25% of the drug costs. The
investigators say that the cost of treatment would have been reduced by 293
euros if they had used a pan-genotypic direct-acting antiviral combination to
avoid genotyping and used blood tests alone to determine fibrosis.
investigators say that as well as reductions in treatment costs, decentralisation
of treatment from specialist clinics will be necessary, as part of a national
hepatitis strategy that rolls out hepatitis screening and treatment to
non-specialist health facilities.