Hepatitis C elimination – Macro‐elimination

Abstract

In 2016 the WHO set a goal to obtain an 80% reduction in new chronic HCV cases, requiring a level of diagnosis of 90%, treatment coverage of 80% and resulting in a 65% reduction in HCV‐related deaths by 2030. This goal is easier to reach in specific populations such as people who inject drugs (PWID), men who have sex with men (MSM) or blood‐transfusion recipients before screening for HCV became mandatory and in high‐income regions. It is much more difficult to achieve macro‐elimination throughout the population especially in low‐income areas with underdeveloped infrastructures, a high prevalence of HCV and limited economic resources. To achieve the WHO goals by 2030, awareness of HCV must increase and the cascade of care must be improved and implemented. Diagnostic procedures and treatment should be affordable and universally available. At the end of 2017 fewer than 15 countries were on track to reach these goals by 2030.

Characteristics of hepatitis C virus resistance in an international cohort after a decade of direct-acting antivirals

“…1 Substitution frequency after treatment minus substitution frequency before treatment. 2 Acceptable false discovery rate was set at 15% (q-value < − 0.15) 3 Specific amino acid substitution observed within the amino acid position of interest. "Decrease" represents decreased substitution frequency, i.e., the level of wild-type reference amino acid increased.…”

“…The study cohort (n = 3,355) comprised HCV sequences and metadata from the SHARED database collected from Argentina, Australia, Austria, Canada, France, Germany, Israel, Italy, Luxemburg, the Netherlands, Norway, New Zealand, Poland, 1 The number of patients with data available in the specified category 2 Injection drug use and non-injection drug use were not mutually exclusive; 189 (25%) participants engaged in both. Injection drug use and non-injection drug use referred to having a history of drug use, including past and recent.…”

“…Nevertheless, the success of these DAAs has rekindled optimism around the potential for global elimination of HCV, which will rely on the "Treatment as Prevention" approach in the absence of an effective vaccine. 2 One potential barrier to the success of this approach is the selection of drug-resistant viruses. The occurrence of resistance-associated substitutions (RASs), either natural or during treatment, can limit the efficiency of treatment and its scale-up.…”

Blood Transfusion Is Associated with Hepatitis C in the Older Drinking Population: Analysis of the National Health and Nutrition Examination Survey from 2013 to 2018

“…In a large cohort of women in the UK, transfusions in the 21st century were associated with long-term increased risks of liver cancer (11). In 2016, the World Health Organization set a goal to reduce the incidence of chronic hepatitis C by 80% by the year 2030, which would require a 90% level of diagnosis and 80% treatment coverage, resulting in a 65% reduction in hepatitis C-related deaths (25). Treatment of HCV infection has always been very challenging (26).…”

Bulevirtide for treatment of patients with HDV infection and compensated cirrhosis: A (huge?) step in the right direction

“…Most importantly, the daily subcutaneous injections and the need to check platelet count and monitor for side effects related to bile acids increase suggest that treatment with bulevirtide should be managed by expert centres. This finding clashes with the concept of treatment simplification and decentralization which is at the core of hepatitis elimination programmes worldwide 15 . Still we think the efficacy of bulevirtide in chronic HDV infection should not be disregarded, as it finally provides patients with a valid treatment option which can be administered safely also to patients with advanced fibrosis and cirrhosis, thus filling a huge clinical unmet need while also inching closer to the goal of worldwide hepatitis elimination.…”