Hepatitis C: Standard of Treatment and What to Do for Global Elimination

Abstract

Hepatitis C virus infection has a substantial effect on morbidity and mortality worldwide because it is a cause of cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related death. Direct acting antiviral drugs available today have high efficacy and excellent safety and can be used in all patients with clinically evident chronic liver disease and in groups that demonstrate risk behaviors to reduce the spread of infection. The Global Health Strategy of WHO to eliminate hepatitis infection by 2030 assumes “a 90% reduction in new cases of chronic hepatitis C, a 65% reduction in hepatitis C deaths, and treatment of 80% of eligible people with HCV infections”. In this review effective models and strategies for achieving the global elimination of HCV infection are analyzed. The screening strategies must be simple and equally effective in high-risk groups and in the general population; fast and effective models for appropriate diagnosis of liver disease are needed; strategies for direct acting antiviral drug selection must be cost-effective; linkage to care models in populations at risk and in marginalized social classes must be specifically designed and applied; strategies for obtaining an effective vaccine against HCV infection have yet to be developed.

Effectiveness and Safety of Sofosbuvir/Velpatasvir/Voxilaprevir as a Hepatitis C Virus Infection Salvage Therapy in the Real World: A Systematic Review and Meta-analysis

“…Studies were included if they met all of the inclusion criteria as follows: (1) Study design: prospective or retrospective observational cohorts, or any other real world study. (2) Population of study: adults regardless of genotype with chronic hepatitis C who had previously failed combined therapy with DAAs and interferon or interferon-free. Patients with HCC, with or without cirrhosis, coinfected with human immunodeficiency virus (HIV) infection or with hepatitis B virus (HBV) infection were also enrolled.…”

“…Hepatitis C virus (HCV) infection has a great impact on the morbidity and mortality of liver cirrhosis and hepatocellular carcinoma (HCC) patients, and it is a major public health problem in the world [1,2]. Since the introduction of highly effective direct-acting antiviral drugs (DAAS) in 2011, significant changes have revolutionized the field of treatment [3].…”

Utilizing Telemedicine and Modified Fibrosis Staging Protocols to Maintain Treatment Initiation and Adherence Among Hepatitis C Patients During the COVID-19 Pandemic

“…Increasing access to treatment by streamlining the fibrosis staging process and utilizing telemedicine may be an effective and accessible way to help increase treatment engagement across the board and work toward that goal, even as health care operations begin to return to pre-pandemic functioning. 19 Looking at treatment result data, we see that SVR confirmation was statistically higher among the control group when compared to the modified workflow group (85.42% and 66.02% respectfully). These data are acceptable results given the length of time patients were observed and shows both protocols are effective in achieving SVR.…”

“…Increasing access to treatment by streamlining the fibrosis staging process and utilizing telemedicine may be an effective and accessible way to help increase treatment engagement across the board and work toward that goal, even as health care operations begin to return to pre-pandemic functioning. 19 …”

Collaborative Referral Model to Achieve Hepatitis C Micro-Elimination in Methadone Maintenance Treatment Patients during the COVID-19 Pandemic

“…On 1 January 2019, the Taiwan National Health Insurance (NHI) authorized coverage of DAA prescriptions for all HCV-viremic Taiwanese citizens, but DAA therapy must be prescribed by hepatologists or infectious disease (ID) specialists. The HCV care cascade can be divided into several steps, including screening (anti-HCV testing), diagnosis (HCV RNA testing), linkage to care and anti-HCV treatment [ 20 ]. Although MMT, liver and ID clinics were located in the same hospital in the present study, referral of HCV-infected MMT patients to liver or ID clinics is still needed for HCV treatment.…”