The State of São Paulo Forum on NGO/AIDS, the GIV – Group for Life Incentive and the Brazilian National Network of People Living with HIV/AIDS in State of São Paulo (RNP+SP) sent a letter, at Tuesday 11/23 to the Ministry of Health Department on STI, AIDS and Viral Hepatitis executive board, on the issue of the treatment for Hepatitis C in Brazil.

Check the letter below.

São Paulo, November 23, 2017.
Excellency Mrs.
Dr. Adele Benzaken
Head mistress
Department on STI, AIDS and Viral Hepatitis – DIAHV
Ministry of Health
Brasília – DF
Dear Mrs. Benzaken,
During the 11° Congress on HIV/AIDS and the 4° Congress on Viral Hepatitis, held from September 26th to 29th, 2017, in Curitiba, the DIAHV reported a new estimating from the result of 0,7%  HCV- positive screening cases, summarized on the chart below:
 Estimated Prevalence of People Living with Hepatitis C age 15 – 69 (2016)
Antibody Prevalence
Total Infected
Viremic Prevalence
60,7% of previous ones
Viremic Cases
During the same Congress, it was reported estimated cases by disease stage, frameworked  below:
Estimating Distribution by Stage of Disease
F4 (cirrhosis)
Descompensated cirrhosis
Related deaths
Also, according to the Epidemiological Bulletin  on Viral Hepatitis 2017 (page 21) there are, from 2007 to 2016, 149.537 confirmed cases of hepatitis C, of which 9,8% correspond to HIV coinfection, it means 14.654 people.
It is relevant to observe that the information reported on 07/27/2017, World Hepatitis Day’s eve, that the  Ministry of Health estimated that in the near future 135.000 patients with hepatitis C would receive treatment in order to provide treatment for everyone. This number does not match with the number of prevalence cases (656.000 patients who need treatment) disclosed in Curitiba. We cannot agree with the optimistic egregore surrounding the report that announces ceasing the queues  for patients on the F3 and F4 stage, since they are about 180.000 people, estimated by the sample above.
The next chart presents the database of treatments with DAAs, kindly provided by this Department and by the State of São Paulo Programme on Viral Hepatitis.
 HIV-Hep. C Coinfected
City of São Paulo
7.185 (09/18/2017)
1.031 (09/18/2017) (14,4%)
State of São Paulo
23.466 (09/18/2017)
3.070 (09/18/2017) (13,1%)
57.080 (until the third trimester)
3.649 (07/03/2017) (6,4%)
The DIAHV also reported that from October 15th on, it would be made available 25.000 new treatments.
Thus, it is obvious that most of the coinfection treatments  were provided to the State of São Paulo, in a over 70% ratio, that does not correspond neither to the State population comparing to Brazilian population, nor to the people coinfection ratio in Brazil. That shows the necessity of more state and municipal campaigns in order to accelerate better distribution and coverage. In fact, more than 14.000 cases of confection have been diagnosed, although the treatments accumulated since October 2015 were less than 4.000 ones. Since all those people probably are attended HIV health programmes, it is necessary and possible to increase the amount of treatments rapidly.
The proportion of treatment for coinfected patients comparing to the monoinfected by Hepatitis C in Brazil and in the State of São Paulo also is worth of attention. It doubles the proportion when it comes to the city and State of São Paulo comparing to Brazil, with 41% total ratio. It causes surprise since the treatment for monoinfected individuals depends on fibroscan testing, not available in every healthcare service, unlike the treatment for coinfected individuals. It is important to highlight that the HCV screening and diagnosis is fundamentally an attribute of States and Municipalities.
The Brazilian Government purchases the medicines at too high prices, that justifies the barriers on the treatment, that selects individuals by fibrosis stages or other issues. On the other hand, other developing countries offer universal treatment for Hepatitis C. Egypt has already offered treatment for over 1,4 million individuals currently paying less than U$ 180 per treatment. Malaysia has enacted compulsory licence for government use and probably will spend less than U$ 300 per treatment. 
Therefore, we request from this Ministry that:
  1. Intercede with the States and Municipalities on the treatment of individuals with Hepatitis C and HIV;
  2. Head campaigns for diagnosis and treatment of people in stage F2 or more advanced.
  3. Get more advantageous prices, like so many other developing countries, to treat people with Hepatitis C, using the safeguards set out in our Patent Law 9279 and the TRIPS Agreement;
  4. Refrain from spreading utopian news as “queues zero”, when in fact what is happening is the failure on diagnosis and access to healthcare, and starting requesting Brazilian people to undergo HCV tests. 
Rodrigo Pinheiro                      Claudio Pereira               Paulo Giacomini


FOAESP                                      GIV                            RNP+SP