Is elimination of HCV realistic by 2030: France

Abstract

The World Health Organization (WHO) has proposed a plan for the elimination of viral hepatitis with a goal of reducing new hepatitis infections by 30% and 90% in 2020 and 2030, and associated mortality by 10% and 65% respectively. Actions and targets to reach these goals include improving hepatitis B virus (HBV) vaccination programs, the prevention of mother‐to‐child transmission of HBV, improving the safety of blood products and injections, risk reduction policies and optimizing the diagnosis and treatment of hepatitis. The goal of eliminating hepatitis C virus (HCV) by 2030 is based on three main actions: increased screening, strengthening access to care and the prevention of infections and re‐infections. But, can this goal be reached? The answer to this question is yes in some countries, perhaps in others and no in most countries. Success will be limited by a “diagnosis burn‐out” with 5 times more new viral infections than diagnoses in 2016 and a “treatment burn‐out” with cure rates that are 5 times lower than the number of new infections. Nevertheless, France, like 10 other countries, is on track to achieve the WHO elimination plan by 2030. In France, the prioritization of oral antivirals in 2013‐2014 which was extended to high‐risk populations in 2015 (HIV‐infected patients) and 2016 (men who have sex with men, dialyzed or kidney transplant recipients), then in 2017 to universal treatment with full coverage by French national healthcare (10 to 15 000 treatments per year) has resulted in half of the 120 000 patients needed to be treated by 2022 have been treated. Renewed efforts should make it possible to reach the target announced by the French Minister of Health in May 2018 by 2025.

Impact of direct‐acting antiviral treatment for hepatitis C on cardiovascular diseases and extrahepatic cancers

“…The introduction of direct‐acting antiviral (DAA) agents has reduced the development of hepatocellular carcinoma (HCC) and all‐cause mortality in chronic hepatitis C (CHC) patients 1,2 . Consequently, universal access to DAAs was implemented in August 2017 in France, following a priority access policy adopted in December 2013 restricting DAAs to patients with advanced liver disease and high‐risk populations 3 …”

“…1,2 Consequently, universal access to DAAs was implemented in August 2017 in France, following a priority access policy adopted in December 2013 restricting DAAs to patients with advanced liver disease and high-risk populations. 3 It is now well established that HCV-induced immune dysregulation and persistent inflammation explain the occurrence of several extrahepatic manifestations. [4][5][6] In particular, HCV infection is recognized as a risk factor for the development of several cardiovascular diseases.…”

Towards hepatitis C elimination in France: Scanvir, an effective model to test and treat drug users on dedicated days

“…The prevalence of chronic HCV infection among PWIDs is approximately 40%. A major barrier to the French national goal ‘2025 without Hepatitis’ 1,8–10 is that many patients are unaware of their status.…”

Performance of algorithms for identifying patients with chronic hepatitis B or C infection in the french health insurance claims databases using the ANRS CO22 HEPATHER cohort

“…Furthermore, some patients received DAAs before the universal access to DAAs in France or as part of clinical research protocols that could not be identified in the SNDS. As many DAAs are now also dispensed in pharmacies, they are now better recorded in the SNDS 33 . It is, therefore, expected that the actual performance of the algorithms for identifying CHC patients treated with antivirals will be higher.…”

“…As many DAAs are now also dispensed in pharmacies, they are now better recorded in the SNDS. 33 It is, therefore, expected that the actual performance of the algorithms for identifying CHC patients treated with antivirals will be higher.…”