Hepatitis C Virus Infection Will Be Rare in 22 Years

Lara C. Pullen, PhD

August 06, 2014

The burden of hepatitis C virus (HCV) infection is expected to be greatly reduced by new all-oral direct-acting antivirals and birth-cohort screening recommendations. Experts suggest, however, that even more aggressive screening recommendations are needed to identify and treat currently infected patients.

Mina Kabiri, MS, from the University of Pittsburgh Graduate School of Public Health in Pennsylvania, and colleagues present the results of their individual-level state transition model in an article published in the August 5 issue of the Annals of Internal Medicine. They evaluate the effect of the availability of direct-acting antivirals as well as new screening recommendations on the future burden of HCV infection in the United States.

The team based their historical numbers on data from the National Health and Nutrition Examination Survey of 1999 to 2002. Using those numbers as the initial input, their model estimated that at this time, there are only 2.3 million chronically infected patients in the United States, which is a much lower number than the commonly reported estimate of 3.2 million.

"Our model estimated that 2.3 million persons were chronically infected with HCV in the beginning of 2013 compared with 3.2 million persons in 2001. With the implementation of birth-cohort screening and the availability of highly effective new therapies, HCV infection could become a rare disease by 2036. In addition, these changes could substantially decrease the overall clinical burden associated with HCV infection in the United States," the authors write.

Screening has become a particularly useful tool because of the new all-oral drugs, which will simplify treatment and remove a burden from hepatologists. The investigators modeled the effect of these new drugs by inputting sustained virologic response rates obtained from phase 2 and 3 clinical trials.

The authors also note that although current birth-cohort screening recommendations will effectively decrease disease burden over time, they will miss a large number of existing patients with HCV infection who would benefit from treatment.

Carlos Romero-Marrero, MD, a hepatologist with Cleveland Clinic in Ohio, who is not affiliated with the study, read the new research for Medscape Medical News. He noted, "One of the main challenges with regard to new HCV treatment access is the high cost of medications, which is more than $80,000 for 3 months of currently available interferon-free oral [direct-acting antiviral] regimes. The safety profile of the new medications with lack of clinically significant side effects broadens the access to caregivers capable of treating HCV patients. Therefore, the results of this study are not surprising yet will need a comprehensive public health approach emphasizing screening, education, prevention, and treatment access."

This study was supported by the National Institutes of Health. One coauthor has reported receiving grants from the National Institutes of Health during the conduct of the study and personal fees from Merck & Co Inc and Gilead Sciences outside the submitted work. Another coauthor has reported receiving support from the National Institutes of Health and grants from the National Science Foundation. The other authors and Dr. Romero-Marrero have disclosed no relevant financial relationships.

Ann Intern Med. 2014;161:170-180. Abstract

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