Hepatitis C Elimination is Possible, But Difficult to Implement

According to a new study published in The Lancet, a complete plan that includes prevention, screening, and treatment interventions could prevent approximately 15.1 million new hepatitis C virus (HCV) infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030.

The interventions modeled by the study suggest that estimates would reach the elimination target set by the World Health Organization (WHO) to reduce the number of new HCV infections by 80%, but miss the target to reduce mortality by 65% by 2032. The goals set by the WHO were meant to be achieved through preventing transmission by improving blood safety and infection control measures, expanding testing, and increasing treatment with direct-acting antivirals (DAAs) for those already infected.

For the study, researchers created a model of the global HCV epidemic in 190 countries using data on demography, people who inject drugs, current treatment and prevention programs, historic trends, prevalence, and mortality rates.

They then estimated the effects of the 4 interventions: implementation of comprehensive blood safety and infection control measures; expansion of harm reduction services, such as opioid substitution therapy and needle and syringe programs for people who inject drugs; provision of treatment for all individuals as soon as they are diagnosed with HCV infection; and expansion of HCV testing, so 90% of those with HCV are diagnosed and offered treatment by 2030.

According to the statement, if current strategies remain, the estimated number of individuals living with HCV infection will gradually decrease to 58 million by 2050 but could rise by the end of the century.

The study estimates that implementing comprehensive blood safety and infection control measures could reduce the number of new infections in 2030 by 58% compared with continuing current control practices. In addition, extending harm reduction services to 40% of people who inject drugs could reduce the number of new infections by an additional 7 percentage points. Together, this would prevent 14.1 million new infections by 2030, but these reductions would not immediately translate into reduced mortality, according to the authors.

To cut future mortality rates more substantially, expanding access to DAAs will be essential. Replacing older treatments with DAAs in all countries and offering these to all patients at the time of diagnosis could prevent 640,000 deaths from liver cancer and cirrhosis by 2030, the authors wrote.

Combining all 3 interventions and adding screening so that 90% of individuals with HCV are diagnosed and offered treatment by 2030 would result in the biggest reductions and avert 15.1 million new HCV infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030.

The study suggested that countries such as China, India, Pakistan, and Egypt, which contribute the most projected new infections by 2030, would need to implement this package in its entirety. The authors also noted that efforts to eliminate HCV will mean considerable challenges and costs. Although the concept is achievable, the analysis indicates that the process to elimination will be difficult. Identifying the resources for cost and expansion will be particularly difficult at a time of reduced investment in global health and a shift in focus toward universal health coverage rather than disease-specific programs, according to the authors.

Reference

• Heffernan A, Cooke G, Nayagam S, et al. Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model. The Lancet. Vol. 393, Issue 10178, P1319-1329. Published March 30, 2019. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32277-3/fulltext. Accessed October 8, 2019.