Viral Hepatitis C Pandemic: Challenges and Threats to Its Elimination

Laura Krekulova; Radkin Honzák; Lee W. Riley


J Viral Hepat. 2021;28(5):694-698. 

In This Article

Obstacles to the Who Plan

In theory, we have everything available to achieve successful elimination of hepatitis C according to the WHO plan. We have diagnostic tools that are sensitive and specific enough to diagnose HCV infection. There are also safe and accurate techniques to measure the severity of liver tissue damage, rather than a painful liver biopsy. Nowadays, we can evaluate liver fibrosis or cirrhosis with non-invasive elastography. Besides being non-invasive, the advantage of elastography is that it is easy to perform, can be operated by certified nurses or X-ray technicians, and more significantly, can be performed on an outpatient basis, even outside of a medical facility. This is highly important because it can increase accessibility and help to speed up the diagnosis and indication of treatment in many types of clinical settings.

Last but not least, the new treatment for hepatitis C is readily available and these new antiviral medications have good tolerance profiles and high efficacy, offering a unique opportunity to achieve HCV elimination worldwide.

Theoretically, we are ready for action to eliminate HCV infection. Evidence-based medicine, however, shows us that, regardless of all the knowledge, tools and treatment regimens, we are not quite prepared to achieve the elimination goals. Unfortunately, the reality of life situations shows us, like a reflection in a mirror, that not all plans and procedures work in accordance with evidence-based assumptions. There is, according to our experience and opinions, something irrational that prevents us from smoothly accomplishing elimination which we expected at the beginning.

There are still many obstacles to accomplishing all the steps to global hepatitis C elimination.

The most common barriers to this goal in the majority of countries are the insufficient political will to describe and establish the priority for HCV infection control, and lack of national screening and elimination programmes.[24]

It is obvious that without the active approach covering the whole population of each country, the elimination or significant reduction in HCV infection prevalence and incidence will never become real and achievable. Besides political will and financing issues, there are also treatment restrictions, which differ from country to country.[24,25]

For example, in some countries, there is a requirement of minimum liver fibrosis stage (F2) before treatment can be considered. Also, some countries require abstinence of > 6 months for active alcohol and drug users to be eligible for treatment and reimbursement. Only Liechtenstein and Switzerland prioritize PWID for treatment regardless of active substance use or liver fibrosis stage.[25]

Most countries and jurisdictions in Europe require a specialist (gastroenterologist, hepatologist, infectious disease specialist, etc.) or even specialized centres to prescribe DAAs for HCV. However, in some countries (e.g. UK, Germany) general practitioners can prescribe reimbursed DAAs.

The lack of medical staff capacity, as well as linkage to care programmes represent additional challenges.[26]

Besides, all above mentioned problems that are likely manageable with adequate political will and support, currently, the major obstacle to HCV elimination is the infected patients themselves. The spectrum of HCV-infected patients has changed over the years.

Earlier, in the 1980s and 90s, viral hepatitis C was mainly an iatrogenic infectious disease.

At present, in developed European countries and in the USA, it is largely an infectious disease associated with PWID.[7,9]