United States Falling Behind Other Countries Eliminating Hepatitis C

Nine countries are on track to eliminate the hepatitis C virus (HCV) by 2030, current estimates from the Polaris Observatory show.

Australia, Egypt, France, Georgia, Germany, Iceland, Japan, the Netherlands, and Qatar are all set to wipe out the liver-attacking disease by the World Health Organization’s target date, according to the Lafayette, Colorado-based Polaris.

“Countries like Australia, Egypt and the Republic of Georgia have made the elimination of HCV a political priority and have allocated the resources to make it happen,” Michael Ninburg, MPA, president-elect of the World Hepatitis Alliance, told MD Magazine.

Based on current policies, the US is 1 of 22 nations including Spain, the UK, Canada and Iran that are "working towards" HCV elimination.

For China, Russia, India, and some 5 dozen other countries, the 2030 goal is unachievable given existing policies, Homie Razavi, PhD, MBA, told MD Magazine. Razavi is managing director of the CDA Foundation, which oversees Polaris’s mission of supplying data, training and analytics to end viral hepatitis.

Treating more than 7% of the HCV infected population with no restrictions, working on harm reduction, and screening patients are key requirements for reaching the 2030 target, Razavi said.

“The US is already treating more than 7% of the infected population, but it needs to remove restrictions so that therapies are available to all — independent of fibrosis stage,” Razavi said.

Brazil, which hosted the World Hepatitis Summit in Sao Paulo from November 1 to 3, will appear on the “on track” list in 2018, he said. The country has pledged to open access to everyone next year, screen the whole population, and treat 100,000 patients per year.

“Brazil did announce at the WHS that they will do everything above in 2018 and they will be on the Polaris list next year,” Razavi said.

Australia, 1 of the 9 countries already on track to attain the 2030 target, has been at the forefront of HCV elimination efforts.

The country was among the first to subsidize new HCV medicines, making a range of direct acting antiviral (DAA) drugs available starting on March 1, 2016.

In August 2017, the government announced it would subsidize Gilead Sciences’s Epclusa (sofosbuvir/velpatasvir).

Australia treated 32,400 of its chronic HCV patients (14%) in 2016, Greg Dore, head of the Viral Hepatitis Clinical Research Program at the Kirby Institute in Sydney, told MD Magazine in August.

A Kirby report released earlier this year estimated that Australia is set to eliminate HCV by 2026 — 4 years earlier than the WHO’s goal.

The WHO targets include a 90% reduction of new hepatitis B (HBV) and HCV infections and a 65% reduction in mortality related to hepatitis by 2030. The organization set these goals in 2016.

The United States is not among the “on track” countries because the combination of baby boomer and risk-based screening isn't working, Ninburg said. The CDC recommends that the baby boomer generation born from 1945 to 1965 be screened, but that may not be adequate, Ninburg said.

“If we are going to get anywhere near elimination of HCV, we need a one-time HCV test for all adult Americans and serial testing for those with ongoing risk factors,” he said. “We also need real leadership from the federal government to make elimination a priority.”

Razavi agreed that expanded screening is key. He also stressed the need for harm reduction programs such as needle exchanges, safe injection rooms, and opioid substitution centers. Most new US cases of HCV arise among injecting drug users, according to the CDC.

Countries should look for “national screening campaigns and removal of restrictions so that anyone who is found infected can be treated,” Razavi said.

A press release regarding the estimates were made available.

This article was originally published by MD Magazine.