Viral Hepatitis C Pandemic: Challenges and Threats to Its Elimination

Laura Krekulova; Radkin Honzák; Lee W. Riley

Disclosures

J Viral Hepat. 2021;28(5):694-698. 

In This Article

Plan of HCV Pandemic Elimination

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, including the goal to stamp out HCV infection as a public health threat by 2030.[4,14]

In May 2016, WHO presented an action plan to get the hepatitis C pandemic under control, with the vision of global HCV infection eradication in the future.[4]

WHO HCV elimination targets are defined as:

  1. 65% reduction in mortality,

  2. reduction in new infections by 90% by 2030, compared with the 2015 baseline,

  3. increase in the proportion of diagnosed people with HCV infection up to 90%[4]

This elimination should be achieved through a combination of preventing transmission by improving blood safety and infection control measures, extending harm reduction services aimed at reducing transmission among PWID, and expanding testing and direct acting antiviral (DAA) treatment for those already infected.[14,15]

With the introduction of DAA regimens in hepatitis C therapy, we are able to cure chronic HCV infection. Since 2014, the first WHO goal—the reduction in the number of hepatitis C-related deaths—is manageable and reachable. The treatment with new all-oral DAA combinations is efficient and safe even for patients with HCV-related liver cirrhosis and advanced liver disease. Before the DAA era, treatments of advanced liver disease or HCV infection in patients with other comorbidities were often very limited or contraindicated.[16,17] With the vision of decreasing incidence and eliminating hepatitis C by the year 2030, there is a need to treat and cure more than 10% of the infected population in each country. Only three EU countries (Germany, the Netherlands and France) have achieved this target in 2015.[16] This clearly demonstrates that the planned decrease in hepatitis C incidence represents a challenge. PWID are considered to be the most vulnerable group for HCV transmission. Transmission in this group can be controlled with expansion of harm reduction programmes and unlimited DAA treatment.

Studies clearly demonstrated a significant 50% decrease of the incidence of HCV infection among opioid substitution treatment (OST) programme participants. The efficacy of OST is boosted up to 74% with simultaneous participation in exchange programmes based on using new sterile needles and syringes only.[18–20] Last but not least, the treatment as prevention strategy has proven to be effective among PWID.[21,22]

Open access to diagnostic tools and DAA therapy for all infected subjects is the key to HCV infection elimination. It is also extremely important to treat the majority of infected patients within a limited time frame of a few years. Only this approach will lead to a decrease in infection reservoirs and reinfections among PWID. Increased case finding followed by their treatment and cure will reduce HCV-related deaths by 65%. This decrease will represent 148 000 end-stage liver disease-related deaths in the year 2023, which will contribute to a 70% decrease in the incidence of hepatocellular carcinoma (HCC). In general, early diagnosis and cure of HCV infection can prevent 640 000 deaths due to liver disease and cancer.[23]

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