Hepatitis C: Is Eradication Possible?

Andrea Lombardi; Mario U. Mondelli; ESCMID Study Group for Viral Hepatitis (ESGVH)

Disclosures

Liver International. 2019;39(3):416-426. 

In This Article

Abstract and Introduction

Abstract

Hepatitis C has a relevant global impact in terms of morbidity, mortality and economic costs, with more than 70 million people infected worldwide. In the resolution, "Transforming our world: the 2030 Agenda for Sustainable Development" was included as a focus area in the health-related goal with world leaders pledging to "combat" it by 2030. In response, WHO drafted the Global Viral Hepatitis Strategy carrying the ambitious targets to reduce the number of deaths by two-thirds and to increase treatment rates up to 80%. Despite the availability of highly effective therapeutic regimens based on direct-acting antivirals many barriers to HCV eradication still remain. They are related to awareness of the infection, linkage to care, availability of the therapeutic drug regimens and reinfection. Overall, if an effective prophylactic vaccine will not be available, HCV eradication appears difficult to achieve in the future.

Introduction

Only 30 years have elapsed since the discovery of hepatitis C virus (HCV), and many are convinced that we are entering in the dusk era of this infection. Since 2014, the widespread availability of all-oral, short-course, well-tolerated and extremely effective drug regimens based on direct-acting antiviral agents (DAAs) have dramatically changed the landscape of HCV therapy. What once was a chronic disease, that could be eradicated in only a fraction of patients with a long and side-effect prone therapy has evolved into a disease that can be eradicated in 8-12 weeks, in almost all patients with no significant comorbidities, taking one to three pills daily.[1] Despite this epochal event, and the fact that the number of HCV viremic patients was already decreasing since 2007, HCV infection still is a global concern.[2] Based upon the latest reports, there are around 71 million people infected with HCV, for a global prevalence of 1.0%.[2] The number of HCV-related deaths has increased from 200 000 per year in 2000 to 400 000 per year in 2015, in contrast to the decrease in deaths related to HIV/AIDS, TB and malaria.[3] The prevalence of advanced liver disease and the corresponding cost for health system will increase further in the future if specific actions against HCV are not adopted.[4] Despite some recent controversial results from a Cochrane meta-analysis, which was unable to determine the effect of DAAs on hepatitis C-related morbidity and all-cause mortality, data from observational studies and trials using surrogate outcomes show that modern pan-genotypic DAA regimens are efficacious against HCV-related morbidity and mortality, also in patients with early fibrosis/non-advanced liver disease.[5,6] Notwithstanding, HCV prevalence is declining in the general population, HCV incidence is increasing between special populations such as persons who injects drugs (PWID), men who have sex with men (MSM) and prisoners. In this article, we will review the perspective of HCV eradication, especially in view of the United Nation resolution on 2030 Goals for a Sustainable Development and the World Health Organization (WHO)'s Global health sector strategy on viral hepatitis, 2016-2021 (GHSS).

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