Top 10 HIV and hepatitis C stories of 2018

2018 has been a pivotal year for HIV and hepatitis C prevention, testing and treatment. Researchers and clinicians have pioneered game-changing HIV treatment regimens, Canadian liver experts have expanded recommendations for hepatitis C testing, and the overdose crisis has triggered an unprecedented response from harm reduction workers, coast to coast.

From the good news to the bad, below are the top 10 stories that made headlines in 2018, as determined by our readers.

10. Three new Canadian strategies launched to address HIV and hepatitis C

In July 2018, the Public Health Agency of Canada published a “framework for action” that sets out key areas of action for the federal government to reduce the health impact of HIV, hepatitis C and other sexually transmitted and blood-borne infections: collecting and using data, initiatives to eliminate stigma and discrimination, reviewing and revising laws and policies, facilitating access to basic needs, and supporting access to mental health services and harm reduction. Simultaneously, the Canadian Foundation for AIDS Research (CANFAR) published a report outlining goals and practical solutions to “end the HIV epidemic in Canada in five years”. And similarly, the Canadian Network on Hepatitis C (CanHepC) is developing a “blueprint” with specific goals, targets and actions to eliminate hepatitis C by 2030.

9. Drug regulators caution women living with HIV about dolutegravir

Regulatory bodies around the world issued precautionary advice to HIV-positive women earlier this year, based on preliminary results from one Botswana study indicating a possible association between the anti-HIV drug dolutegravir and a birth defect. Although the study did not prove the cause of the defect, Health Canada advised women living with HIV and their healthcare providers to consider the risk and discuss alternatives to dolutegravir if pregnancy is a possibility. This precautionary warning presents a dilemma for women living with HIV, as dolutegravir has demonstrated high effectiveness and fewer side effects in clinical trials, compared to many other regimens.

8. Survey says HIV and hepatitis C stigma is high among Canadians

A 2018 Ekos survey, conducted on behalf of the Public Health Agency of Canada, aimed to assess levels of awareness, knowledge and attitudes related to HIV, hepatitis C and other infections. Of the 2,452 Canadians surveyed, most were unaware of new developments in HIV such as pre-exposure prophylaxis (PrEP) or HIV treatment as prevention. A majority incorrectly believed there is no cure for hepatitis C, and incorrectly believed there is a hepatitis C vaccine. Yet the most alarming findings were around stigma. One in four respondents said they would be uncomfortable working around or having casual contact with someone with hepatitis C, despite no risk of transmission. And one in four respondents would not use the services of a hairstylist or barber who is HIV-positive – again, despite no risk of transmission.

7. The first dual therapy for HIV approved in Canada

Since the advent of effective combination antiretroviral treatment for HIV in the 1990s, triple therapy – three drugs taken daily as a regimen – has been the standard of care for people living with HIV in Canada. As people live longer with HIV and are concerned about the long-term effects of taking daily medication, researchers have been investigating ways to simplify treatment by using fewer but more potent medications. This year, Health Canada approved the first dual therapy regimen to treat HIV, combining the drugs dolutegravir and rilpivirine into one pill. For now, the two-in-one pill is only indicated for people who have already achieved viral suppression on triple therapy. However, research presented at this year’s International AIDS Conference suggests that a different dual therapy (dolutegravir + 3TC) may also be effective as a first-line regimen for people diagnosed with HIV.

6. Overdose prevention sites pop up across the country

With nearly 4,000 deaths attributed to opioids in 2017, Canada is in the midst of a significant overdose crisis. Harm reduction workers and other frontline service providers across the country have taken matters into their own hands, opening up supervised consumption services and overdose prevention sites – with and without legal permission. Not only do these services prevent HIV and hepatitis C transmission by providing sterile drug use equipment, they also save lives by preventing overdoses with oxygen, stimulation and naloxone. Over the course of seven months, the unsanctioned Moss Park overdose prevention site in Toronto responded to more than 200 overdoses, and no deaths occurred.

5. Study finds that HIV can be more harmful for some people in Saskatchewan

Researchers from the British Columbia Centre for Excellence in HIV/AIDS stunned the world this year when they presented data at the International AIDS Conference suggesting some people in Saskatchewan were more susceptible to immunological injury caused by HIV. After analyzing the genetic sequences of the virus among people living with HIV in the province, they discovered that some strains of the virus had adapted to people’s natural immune defences, which could make AIDS appear faster. While these strains are still expected to respond well to HIV treatment, the faster progression of the virus makes the need for prompt testing and treatment even more pressing in Saskatchewan, which already has the country’s highest rate of new HIV infections.

4. Hepatitis C treatment restrictions lifted in all provinces and territories

Thanks to new clinical guidelines and reduced prices negotiated by governments with major pharmaceutical companies, public drug plans across the country have now eliminated restrictions on hepatitis C treatment coverage that had been originally put in place to ration drug coverage for the most advanced cases. Previously, patients had only been eligible for public coverage of modern hepatitis C medications when their liver injury had become severe. With universal treatment now in place in all jurisdictions, hepatitis C can be cured quickly and efficiently – minimizing the long-term consequences of liver damage and the chance of passing the virus on to someone else.

3. Canada meets the third 90-90-90 target, still behind on testing and treatment

In 2016, Canada signed on to the global 90-90-90 targets for HIV by 2020: 90% of people living with HIV being diagnosed, 90% of those diagnosed starting treatment, and 90% of those on treatment achieving viral suppression. It is projected that meeting these targets will end AIDS as a public health threat by 2030. In 2018, the Public Health Agency of Canada issued new estimates of our progress on the three targets. The good news is that we have met the third target: 91% of HIV-positive Canadians on treatment have achieved viral suppression, meaning they are more likely to live longer and healthier lives, and cannot pass on the virus sexually. The bad news is we are still behind on the first two targets: only 86% of people living with HIV have been diagnosed, and only 81% of those diagnosed are on treatment.

2. New Canadian hepatitis C guidelines broaden testing recommendations

In its updated guidelines for the clinical management of hepatitis C, the Canadian Association for the Study of the Liver now recommends the universal treatment of all people with hepatitis C, irrespective of the extent of their liver injury or whether they use drugs. But perhaps the most newsworthy aspect of the new set of guidelines was the recommendation that clinicians offer a one-time hepatitis C test for all Canadians born between 1945 and 1975, in addition to high-risk groups. This contradicts an earlier recommendation issued by the Canadian Task Force on Preventive Health Care last year, which only recommended hepatitis C screening for people who fall into high-risk categories. Hepatitis C advocates had disagreed with this earlier recommendation, pointing out that a person can live 20 to 30 years after infection without showing any symptoms, making a universal approach to screening more effective.

1. Canada becomes the first country in the world to endorse U=U

“Undetectable = Untransmittable”, or U=U, is the global rallying cry of a movement to share the scientific fact that a person living with HIV who achieves an undetectable viral load cannot pass on the virus to their sexual partners. CATIE endorsed this message early in 2017, and we welcomed the endorsement of Canada’s Chief Public Health Officer Dr. Theresa Tam at last year’s CATIE Forum. At this year’s International AIDS Conference, Canada’s Minister of Health Ginette Petitpas Taylor announced her support of U=U and challenged other health ministers from around the world to proclaim the message in their own countries. And on World AIDS Day, Canada became the first government in the world to endorse U=U.