Micro‐elimination of hepatitis C virus

Abstract

Background & Aims HCV affects about 71 million people worldwide with 1.75 million new infections a year, mainly associated with healthcare, blood transfusion before screening of donors and drug use. Hepatitis C is a systemic disease with hepatic and extrahepatic manifestations resulting in increased morbidity and mortality in HCV‐infected patients compared to cured or uninfected individuals. Results The goal of eliminating hepatitis C by 2030 is based on the following three main actions: strengthening and increasing outreach screening; increasing access to treatment; and improving prevention. Although the tools and the targets of HCV elimination have now been well established, micro‐elimination, a cure in high‐risk populations, is possible, but has not been achieved. These populations are mainly migrants, prisoners, drug users, HIV co‐infected patients and psychiatric patients. New tools must be developed to achieve micro‐elimination, in particular, rapid diagnostic orientation tests for better screening, delocalization of healthcare services to improve access to care, and training physicians to raise awareness of the disease, increase understanding of its pathogenesis and provide information on the availability of safe and effective treatment to cure chronic infection and reverse hepatic and extrahepatic manifestations. Conclusion Thus, while the goal of complete elimination of hepatitis C virus was feasible in Western countries, it was more difficult in high‐prevalence countries where improvement in the detection of chronic infection (with rapid serological and virological diagnostic tests), outsourcing of diagnostic and therapeutic care and access to direct oral antivirals are urgently needed.

The Prevalence of HCV Infection and Risk Factors in a Hospital- Based Population Screening, a First Step to the Micro-Elimination of HCV Infection in Medical Institutions from Romania - Results of the HepC ALERT Study

“…However, this approach is used also in wealthy countries with very low prevalence such as Belgium or the Netherlands [16][17][18]. This concept targets specific population subgroups : children (under the age of 15 years), HCV/HIV-coinfected persons, birth cohorts, haemodialysis patients, those diagnosed with haemophilia, men who have sex with men, migrants, people with advanced liver disease, people who inject drugs, prisoners, and transplant recipients [7,15,19,20]. In Romania, besides the already mentioned categories, we should include as target populations: people with intrafamilial transmission of HCV, transfusions and abortions during the communist era, subjects with professional exposure to blood products and multiple hospitalizations.…”

Progression to hepatitis C virus micro-elimination in people living with HIV in Spain

“…This strategy is focused on collectives with a high prevalence and/or in those subsets of patients with the worst prognosis in the short term. A proactive policy of searching for patients combined with the lack of restriction on treatment uptake facilitates the success of this strategy [3]. Our results show that after 5 years of proactive treatment implementation, more than 85% of patients were successfully treated, reaching a global HIV/HCV coinfection rate in our cohort of approximately 1%.…”

The Challenging Road to Hepatitis C Virus Eradication

“…Additionally, the risk of reinfection among these people is very high [ 5 ]. This population group includes drug users, the homeless, and people with psychiatric illnesses, among others [ 10 ]. Therefore, the HCV elimination strategy requires reducing risky behaviors, expanding HCV testing, and unrestricted access to treatment [ 7 ].…”

“…Thus, HCV infection prevalence can be substantially reduced through significant increases in the frequency of diagnosis and access to HCV treatment in target populations [ 4 ]. The most pragmatic approach to implementing HCV elimination would be to break down elimination goals into smaller goals for population segments (microelimination) [ 10 ]. Thus, diagnosis, treatment, and prevention interventions could be delivered more quickly and efficiently using innovative methods [ 12 ].…”