Eradicate hepatitis C in the next 10 years

eradication Hepatitis C virus (HCV) has the potential to become a globally viable goal by 2030.

The advent of direct-acting antiviral drugs (DAA) has had a major impact on the spread of the virus, making it very easy to treat patients and eliminate the disease.

However, some concerns remain as to whether this is a realistic goal, especially in low-income countries.

In an interview with HCP Live®Thomas Robertson, MD, FACP, Internal Medicine, Associate Program Director, AHN Internal Medicine Residency Program talked about recent advances in the treatment of HCV and how promising the future is.

HCPLive: What is the gap between the social costs and burdens of hepatitis in developed and developing countries?

Robertson: It really depends on the population being assessed as the type of viral hepatitis. For HBV, there is a large gap between low- and middle-income countries (LMICs) and high-income countries such as the United States.

There are more than 1 million HBV-related deaths worldwide each year, with few deaths primarily due to the spread of vaccination in the United States. For HCV, the burden is even higher in low- and middle-income countries, but relatively higher in the United States (compared to HBV).

This is primarily caused by opioid epidemics, with HCV infection rates increasing by more than 400% in young people over a 10-year period. If liver disease progresses to cirrhosis and the risk of liver cancer is high and left untreated, the burden becomes heavy.

HCPLive: From a US perspective, what is one thing that needs to happen to improve hepatitis treatment?

Robertson: One of the things that needs to happen in the United States is an increase in the number of primary care clinicians who are empowered to treat HCV. This is no longer a subspecialist illness. It can and must be managed within primary care. It’s actually faster than a sub-specialist and can be done with fewer downstream problems, and the data confirms that.

Coupled with this, there is increased screening in the community, especially for those left out of society, more outreach, and more support for substance use treatments. Another thing I emphasize many times is that aggressive drug use and other dangerous behaviors are not a reason not to treat. This violates all available data and guidelines recommendations.

HCPLive: There is always a lot of talk that HCV can eventually be eradicated. Do you think it is possible? If so, what needs to happen for it to happen?

Robertson: This is the WHO and AASLD target for the 2030 HCV removal target. It aims to reduce new infections by 80% and HCV-related mortality by 65% ​​compared to 2015 levels.

Possible by increasing screening, especially reaching out to those who have reached their limits, increasing uptake into treatment by primary care, promoting safe drug use practices, increasing treatment for substance use disorders, believing in the concept of treatment as prevention I think-similar to HIV Campaign-Treat and treat someone’s HCV to eliminate the possibility of that person spreading the virus.

In fact, the model shows an overall reduction in prevalence and infection, suggesting that the incidence could decrease by 90% by 2030 as more people use injectables.

HCPLive: Are there any medications in the pipeline that could help this patient population?

Robertson: The reality and beauty of viral hepatitis today is to have everything we need: a universally effective drug for HCV, and vaccination for HAV and HBV. A modern HCV treatment option called DAA is truly a scientific miracle and one of the most innovative advances in modern medicine.

Treatment includes short-term medication (usually 8-12 weeks) and follow-up blood tests. This results in a cure rate of over 95%. HCV was not discovered until the mid-1990s, and the first treatment was badly tolerated and slightly effective. Since the advent of DAA, cure rates and tolerability have skyrocketed.

Recent advances have been that all DAAs currently in use are pangenomic. This means that because it treats all HCV genotypes, it is much easier for clinicians to understand which drug to use and how to treat it.

For chronic HBV, the effect of treatment is much lower and much longer. What is important is vaccination and prevention by modifying risk factors.

HCPLive: How did the COVID-19 pandemic affect HCV screening? Do you think you will catch up in the future?

Robertson: The pandemic has steadily slowed progress in HCV screening and treatment for a variety of reasons. Deterioration of medical bandwidth, energy, attention, and opioid epidemics on behalf of both clinicians and patients.

So we are here to screen all adult HCVs, burst outside the traditional four walls of the office to meet people in the community, and primary care clinicians involved in the ongoing illness Dangerous behavior on behalf of patients should resume investment in efforts to enable treatment of this treatable disease.