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Triple Test and Treat for HIV/HBV/HCV-Simple Way to Slow Hep Epidemics?
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IAS 2023, July 23-26, 2023. Brisbane
Mark Mascolini
Piggybacking tests for HBV and HCV onto HIV screening could benefit 9 times as many people as testing and treating HIV alone, according to a 175-article analysis by Natasha Beard at Imperial College London and Andrew Hill at the University of Liverpool [1]. And the extra effort could be done at low cost, said the authors of this 56-country study.
While HIV infects an estimated 38.4 million people across the world, HCV infects 58 million and HBV 296 million. Yet an estimated 85% of people with HIV get diagnosed, compared with 21% with HCV and a mere 10.5% with HBV. Respective proportions treated are 75%, 13%, and 2.3%. HIV kills an estimated 650,000 people yearly, compared with 290,000 killed by HCV and 820,000 by HBV.
It costs $47 per year to treat HIV, $29 to treat HBV, and $60 to cure HCV, Beard and Hill figured. Three-in-one tests for HIV-1 and -2 antibody, hepatitis B surface antigen, and anti-HCV antibody sell for $1 per test (Accu-Tell Triple Test), $4.8 (Matemova Triple Test), and $5 (BioSynex Triple Test). Individual tests are even cheaper but not as convenient.
To figure how many more individuals could be diagnosed with HIV/HBV/HCV triple testing than with HIV testing alone, Beard and Hill analyzed 175 reports of people tested in parallel for the three viruses. These reports embraced more than 14 million people in 56 countries, including 11 samples representing the general population, 43 blood donors, 16 pregnant women, 34 healthcare workers, 35 refugees or asylum seekers, 15 prisoners, 4 homeless people, 4 men who have sex with men (MSM), and 13 people who use drugs.
For all these populations combined, HIV prevalence stood at 0.2%, HBV prevalence at 1.1%, and HCV prevalence at 0.7%. Doing the math, the researchers calculated that for every 1 person diagnosed with HIV, triple testing would diagnose 5 with HBV and 3 with HCV. In other words, in the studied populations triple testing would identify 9 people with one of these 3 viruses compared with the single person who would be found with a stand-alone HIV antibody test. In all the populations studied except MSM, combined prevalence of the hepatitis viruses outstripped HIV prevalence.
Screening for all three viruses at the same time makes sense because all three share transmission routes. "If people at high risk of HIV were also tested for HBV and HCV, there is the potential to benefit far more people," Andrew Hill told NATAP in an email. "The treatments for HBV and HCV are also very cheap and widely available as generics." The World Health Organization already recommends triple testing for people who use drugs, prisoners, and MSM.
Reference
1. Beard N, Hill A. Combined "test and treat" campaigns for HIV, hepatitis B and hepatitis C: review to provide evidence to support WHO treatment guidelines. IAS 2023, July 23-26, 2023. Brisbane. Abstract LBPEB03.
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