Challenge of managing hepatitis B virus and hepatitis C virus infections in resource-limited settings

Abstract

The global burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and coinfection represents a major public health concern, particularly in resource-limited settings. Elimination of HCV by 2030 has become foreseeable, with effective direct-acting antiviral oral therapies and the availability of affordable generics in low-and-middle-income countries (LMICs). However, access to oral nucleos(t)ide therapy for HBV remains critical and is limited outside the existing global HIV program platforms despite affordable prices. Prevention of mother-to-child transmission of HBV through scaling up of birth dose implementation in LMICs is essential to achieve the 2030 elimination goal. Most individuals living with HBV and/or HCV in resource-limited settings are unaware of their infection, and with improved access to medications, the most significant barrier remains access to affordable diagnostics and preventive strategies. The coronavirus disease 2019 pandemic interrupted hepatitis elimination programs, albeit offered opportunities for improved diagnostic capacities and raised political awareness of the critical need for strengthening health care services and universal health coverage. This review underpins the HBV and HCV management challenges in resource-limited settings, highlighting the current status and suggested future elimination strategies in some of these countries. Global efforts should continue to improve awareness and political commitment. Financial resources should be secured to access and implement comprehensive strategies for diagnosis and linkage to care in resource-constrained settings to fulfill the 2030 elimination goal.

Trends in hepatitis C virus coinfection and its cascade of care among adults living with HIV in Asia between 2010 and 2020

“…However the current proportions of those with pre-treatment HCV RNA testing (80%) and those initiating HCV treatment (61%) in our cohort fall well below those documented in HIC cohorts: 93% of those anti-HCV positive in a European HIV cohort had a subsequent HCV RNA test [38], and 73% of Australian HCV coinfected PLHIV initiated treatment [36]. It should be noted that HCV cascade performance in the later year of our analysis might have been affected by local COVID-19 epidemics, which negatively impacted chronic HCV screening, treatment initiation, and hepatitis elimination programs in other settings [39,40].…”

A critical review of the prospects and challenges of Hepatitis B therapeutic vaccines

“…Striking a balance between an effective immune response and avoiding collateral damage to the liver is a delicate challenge. Developing and producing therapeutic vaccines can be expensive as such, ensuring accessibility to these vaccines, particularly in regions with high HBV prevalence and limited healthcare resources, is a substantial challenge [52] . The regulatory pathway for approving therapeutic vaccines may be complex and demonstrating safety, efficacy, and long-term benefits in clinical trials poses a challenge for vaccine developers.…”

Single‐tube, single‐strip lateral flow assays utilizing loop‐mediated isothermal amplification for simultaneous hepatitis B and C viral detection

“…However, pan‐genotypic direct‐acting antivirals have transformed HCV treatment, offering over 90% cure rates, even in advanced liver disease, with short treatment durations of 8–12 weeks 10 . Despite these advances, many HCV cases remain undiagnosed and untreated due to limited testing, particularly in resource‐constrained settings 11,12 …”