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by Amanda Conschafter, blog editor

Patients co-infected with hepatitis C and HIV may have newfound hope. Clinical trial results presented at the 2015 Conference on Retroviruses and Opportunistic Infections show that a new combination pill worked for co-infected patients of certain genotypes 96 percent of the time. But can patients access the medicine in time to prevent liver cancer and serious damage from hepatitis?

The new treatment combines two direct-acting antiviral agents, sofosbuvir and ledipasvir, into a once-daily pill. Co-infected patients historically have not responded well to interferon treatments, so their progress with this new therapy marks a significant success. Equally encouraging, patients tolerated the therapy well. No trial participant stopped taking the medication because of adverse reactions.

As with other new hepatitis cures, however, price point will likely determine patients’ access to this medication. Many physicians struggle to get new hepatitis C therapies for their patients because of lengthy prior authorization requirements. Others face insurers and state Medicaid systems’ rationing techniques, whereby patients can access these therapies only at an advanced disease state.

But this approach could endanger patients. According to the UK’s NAM, Swiss researchers have identified startling implications for deferring treatment. Disease progression can be quicker for patients co-infected with HIV and hepatitis C, and if these patients wait until F3 or F4, the final two stages of hepatitis C, they may face liver cancer or death. For some of these patients, liver-related deaths can occur even after hepatitis has been cured.

This data encourages further scrutiny of which patients receive hepatitis C therapies – and when. As debate over access to these new therapies continues, insurers and policymakers must consider the long-term costs, in both dollars and human life, of rationing hepatitis cures to only the sickest patients.

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