Patients seek combined treatment for hepatitis C and HIV

The hepatitis C patient community has reported a problem with medications for Russians infected with a combination of hepatitis C and HIV viruses. According to specialized NGOs, in 2023, only 2.5 thousand such patients will receive free therapy from the state, although there are about 300 thousand of them in the country. The Ministry of Health called the activists’ claims incorrect.

In early April, eight patient organizations sent a collective letter to the Russian Ministry of Health about the problem of lack of government procurement of drugs for the treatment of chronic viral hepatitis C in people with HIV infection. They recalled: procurement within the framework of Russian Government Decree No. 1512 of December 15, 2015 is the only opportunity to receive hepatitis C therapy for such patients. At the beginning of May, the organization “Together against Hepatitis” appealed to the Minister of Health Mikhail Murashko. “Reducing treatment coverage for chronic viral hepatitis C in HIV-infected patients could in the future lead to a significant increase in budget costs and the burden on the health care system caused by an increase in the number of cases of liver decompensation and death in patients,” the authors of the letter indicated. “This will negatively impact key indicators of the State strategy to combat the spread of HIV infection in the Russian Federation for the period until 2030.”

In the summer, the Federal Center for Planning and Organization of Medicinal Provision of Citizens announced several auctions for the purchase of drugs of the sofosbuvir + velpatasvir regimen for a total amount of almost 49 million rubles. According to Together Against Hepatitis estimates, these auctions cover the need for hepatitis C therapy for approximately 2.5 thousand HIV-infected patients. In total, the number of Russians with such diagnoses may reach 300 thousand, social activists say. And they indicate that in 2021, within the framework of Resolution No. 1512, purchases were made for more than 2.2 billion rubles.

On August 1, NGOs sent a new letter to the Minister of Health Mikhail Murashko. They asked to “eliminate the fact of discrimination, ensure full implementation of all provisions of Resolution No. 1512 and the implementation of constitutional rights for Russians infected with a combination of hepatitis C and HIV viruses.” In November, the patient community received a response from the Department for Regulation of Medicines and Medical Devices of the Russian Ministry of Health. Officials called the claims of Together Against Hepatitis incorrect. They stated that “the limits of budgetary obligations for the purchase of antiretroviral drugs for 2023, completed in the prescribed manner, have been accepted in full.” The department’s response also states that the federal center is already purchasing antiretroviral drugs, which are “in acute shortage” in the constituent entities of the Russian Federation, at the expense of the 2024 budget.

Chairman of “Together against Hepatitis” Nikita Kovalenko believes that “in a situation of chronic shortage of program funding,” drugs for the treatment of hepatitis C will be purchased “in minimal quantities.” “We have to admit that no one is interested in treating hepatitis C in HIV-infected patients,” he says. “Unfortunately, until targets for coverage of hepatitis C therapy appear in the State Strategy to Combat the Spread of HIV Infection in the Russian Federation, our “In my opinion, it makes no sense to hope that HIV-infected people will be treated for hepatitis.”

Kommersant sent a request to the Ministry of Health, but did not receive a response at the time of publication. In 2022, patients complained for the first time about problems with the treatment of hepatitis C in HIV-infected people, and then the chief specialist in HIV infection of the Russian Ministry of Health, Alexey Mazus, assured Kommersant that “today there is an absolute readiness of the Russian healthcare system to solve issues of co-infection HIV and viral hepatitis C based on the highest scientific standards, and access to treatment is ensured in full.”

It should be noted that among the latest instructions from President Vladimir Putin to the government of the Russian Federation there was a point about the need to find additional funding for measures to treat patients with hepatitis C. Back in the summer, the Ministry of Health of the Russian Federation proposed additionally funding the program to combat hepatitis C with funds from increasing excise taxes on cigarettes and cigarettes, the cost of which per pack is more than 200 rub. According to media reports, the ministry is lobbying for this idea. In turn, the government included in the draft amendments to the state program “Health Development” the rules for the provision and distribution of federal subsidies to regional budgets to ensure measures to combat chronic viral hepatitis C. “We understand that this was done so that the regions also invest in the treatment of hepatitis. But we are losing the opportunity to significantly reduce prices through large purchases,” comments Nikita Kovalenko. “When each region purchases for itself, discounts from manufacturers and suppliers will be significantly smaller.”

Natalia Kostarnova