Impact of Coronavirus Disease 2019 Pandemic on Viral Hepatitis Elimination: What Is the Price?

Abstract

In 2016, the World Health Organization developed a plan for viral hepatitis elimination by 2030. Globally, control of hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most challenging aspects of viral hepatitis elimination. In many developed countries elimination of HBV could be targeted to special populations mostly immigrants from low resource settings. Elimination of HCV, however, remains a challenge globally. Barriers to HCV elimination include high cost of medications and the ability to engage specific at-risk populations as well as individuals who are out of medical care. In the context of the coronavirus disease 2019 (COVID-19) pandemic, treatment access and screening have been further negatively impacted by social distancing rules and COVID-19-related anxieties. This threatens to throw most countries off course in their elimination efforts. Before the pandemic, some states in the United States had scaled up their elimination efforts with plans to ramp up testing and treatment using Netflix-like payment models for HCV direct acting antiviral drugs. Most of these efforts have stalled on account of the health system's focus on COVID-19 control. To prevent further delays in achieving elimination targets, programs would need to explore new models of care that address COVID-19-related access hurdles. Systems that leverage technologies such as telemedicine and selftesting could help maintain treatment levels. Mathematical models estimate that COVID-19-related delays in 2020 could lead to 44,800 hepatocellular cancers and 72,300 liver-related deaths for the next decade.

Agreement and diagnostic differences among three definitions of sarcopenia in patients with chronic hepatitis C

“…36,37 Among these obstacles, a universal and inclusive healthcare system, an outstanding screening to detect a submerged portion of patients chronically infected with HCV, an equal access to the DAA therapy worldwide, and COVID-19 should be highlighted. [36][37][38][39] Concerning nutrition aspects, in the hepatitis C realworld settings, evidence has shown body weight increases succeeding DAA-induced sustained virological response (SVR). 37,40,41 Additionally, HCV-unrelated steatosis was identified in 47.5% of patients in a US investigation, especially in those with a higher BMI, even after successful virus eradication with DAAs.…”

“…Although the hepatitis C scenario has been strongly modified by the availability of direct‐acting antiviral (DAA) treatment, several unsolved challenges linked to HCV elimination remain 36,37 . Among these obstacles, a universal and inclusive healthcare system, an outstanding screening to detect a submerged portion of patients chronically infected with HCV, an equal access to the DAA therapy worldwide, and COVID‐19 should be highlighted 36–39 …”

Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

“…HIC data collection is being expanded 10 , providing enhanced opportunities to incorporate a wider view of the UK over time. Effort and resources are required to refine telemedicine services and optimise access to laboratory surveillance 15 , re-establish face-to-face services and catch-up on monitoring and interventions. Future analyses are warranted to investigate how imaging surveillance and telemedicine service uptake have been impacted when these data become available in the NIHR HIC database.…”

Impact of the COVID-19 pandemic on routine surveillance for adults with chronic hepatitis B virus (HBV) infection in the UK

“…Different effects may apply in different regions or in more rural settings. Efforts and resources will be required to refine telemedicine services to optimise access to ongoing laboratory surveillance (17), to re-establish face-to-face services and to catch-up on monitoring and interventions for those who have experienced delays. Longitudinal follow-up is warranted to ensure activity is re-aligned in order to support progress to elimination goals, and investigate the relationship between these disruptions and future outcomes, including cirrhosis and hepatocellular carcinoma.…”