COMMENTARY

Hepatitis C: The Pill, $1000; The Cure, Priceless

Digestive Disease Week (DDW) 2015

William F. Balistreri, MD

Disclosures

September 10, 2015

In This Article

Last year marked the 25th anniversary of the identification of the hepatitis C virus (HCV)—and this year is highlighted by the realistic possibility that a significant proportion of patients can be cured of the HCV infection.

The evolving landscape of HCV treatment includes new drugs and new strategies that are better tolerated and more effective than previously used regimens, leading to rapidly changing guidelines for management.[1] These advances are linked to enhanced efforts at early recognition. However, not all eligible patients have been tested, identified, referred for care, and offered treatment.[2,3]

The Current Challenge

HCV infection affects an estimated 185 million people worldwide, with chronic infection often leading to cirrhosis and hepatocellular carcinoma.

Data from 2006-2012 revealed a nationwide increase in reported cases of acute HCV infection in the United States.[4] Adolescents and young adults (≤30 years of age) from nonurban areas accounted for the majority of cases, with approximately 73% citing injection drug use as the principal risk factor. The survey reported a 364% increase in hepatitis C infection among people 12-29 years of age.

Recognition

The recently published guidelines from the Centers for Disease Control and Prevention for comprehensive hepatitis C counseling and testing suggest one-time screening for all baby boomers.

Screening is initiated with anti-HCV testing and then followed with testing for HCV RNA in those with anti-HCV reactivity. HCV RNA-positive persons should be linked to care for treatment of HCV infection.[5]

Incidence in Children

The increasing prevalence of HCV infection has had an impact on children—who are themselves infected via intravenous drug use or via perinatal transmission from an infected mother.[6] However, the true incidence and prevalence rates in children are unknown because the identification of infected children is inadequate.

Delgado-Borrego and colleagues[7] attempted to determine the rate of ascertainment of HCV cases in children compared with the estimated number of actual cases, using data from Florida and US health departments. From 2000 to 2009, only 12% of the expected number of infected children were identified as being anti-HCV–positive in Florida, and an estimated < 2% of the expected number of cases were followed by a pediatric gastroenterologist. Across the United States, < 5% of the expected number of cases were identified.

Lack of identification and lack of treatment of children infected with HCV constitute critical public health problems.

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