Toward the elimination of hepatitis C in the United States

Abstract

The emergence of effective direct-acting antiviral (DAA) agents has reignited discussion over the potential for hepatitis C elimination in the United States. Eliminating hepatitis C will require a critical examination of technical feasibility, economic considerations, and social/political attention. Tremendous advancement has been made with the availability of sensitive diagnostic tests and highly effective DAAs capable of achieving sustained viral response (SVR) in more than 95% of patients. Eliminating hepatitis C also requires escalating existing surveillance networks to monitor for new epidemics. All preventive interventions such as clean syringe and needle exchange programs, safe injection sites, opioid substitution therapies, and mental health services need to be expanded. Although costs of DAAs have raised budget concerns for hepatitis C elimination, studies have shown that eliminating hepatitis C will produce a savings of up to 6.5 billion USD annually along with other intangible benefits such as increased work productivity and quality of life. Economic models and meta-analyses strongly suggest universal hepatitis C screening for all adults rather than just for birth cohort and high-risk populations. Social and political factors are at least as important as technical feasibility and economic considerations. Due to lack of promotion and public awareness, HCV elimination efforts continue to receive inadequate funding. Social stigma continues to impede meaningful policy changes. Eliminating hepatitis C is an attainable public health goal that will require intense collaboration and sustained public support. (Hepatology 2018;67:2449-2459).

Influence of Interferon-free Direct-acting Antiviral Therapy on Primary Hepatocellular Carcinoma Recurrence: A Landmark Time Analysis and Time-dependent Extended Cox Proportional Hazards Model Analysis

“…Interferon (IFN)-free direct-acting antiviral (DAA) therapy has replaced IFN as the standard treatment for hepatitis C virus (HCV) infection based on its high efficacy and tolerability (1,2). It has also been actively used after curative treatment in patients with concurrent hepatocellular carcinoma (HCC).…”

Escape from planned obsolescence: Hepatitis C, the cirrhotic liver, and clonal expansions

“…The causes of the persistent abnormalities are unknown, although a recent study implicated epigenetic changes (Perez et al, 2019). An increase in National Institutes of Health–funded HCV research, which is disproportionately low (see Table 3 of Saab et al, 2018), could save lives by jump-starting efforts to find interventions for the millions of patients with post-cure HCV-related liver damage.…”

Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic

“…An estimated 3.5 million people in the USA are infected with hepatitis C virus (HCV)1–4 with approximately 50% being unaware of their HCV status 5 6. About 15%–25% of people infected with HCV spontaneously clear the virus, while 75%–85% of individuals develop a chronic infection 2 7 8.…”