Accelerating efforts to eliminate hepatitis
Recently, at the 69th World Health Assembly in Geneva, 194 governments adopted the WHO’s Global Strategy on Viral Hepatitis which includes the goal of eliminating hepatitis B and C by 2030. Similarly, the theme of this year’s World Hepatitis Day, which falls on 28 July 2017, is ‘Eliminate Hepatitis.’
Locally, the incidence of hepatitis A, B and C is on the rise. According to MOH statistics, in 2009, the incidence rate was 0.14, 2.13 and 3.71 for hepatits A, B and C respectively. Last year, it was 0.28, 12.6 and 8.57. Bear in mind the recorded figures could be an underestimation of the actual situation as not everyone who seeks treatment or go for executive screening will be offered tests for hepatitis C.
The increased prevalence of chronic hepatitis B and C is worrying as it will increase the number of patients getting cirrhosis and liver cancer. An estimated 40 to 50 percent of patients with cirrhosis due to hepatitis C will develop progressive liver damage and later, liver failure and death.
Despite the existence of oral nucleoside analogues (NUCs) that can effectively suppress hepatitis B virus, the rate of HBsAg clearance is disappointing. Moreover, the medication has to be taken for 5 to 8 years or even for life. Thus, the cure for chronic hepatitis B is still out of reach.
As for hepatitis C, the introduction of novel direct-acting antiviral antigens (DAAs) has changed the treatment landscape. The DAAs can cure chronic hepatitis C; it help can help patients achieve a sustained virological response. However, there are numerous hurdles to overcome to achieve a cure for chronic hepatitis C. As mentioned earlier, the statistics we have at the moment may be an under-estimation of the actual number of hepatitis C patients. This is in view of the large number of overt and covert HIV-hepatitis C virus coinfection. Second, available medications are effective but cost-prohibitive, especially for low and middle income countries.
Concentrated efforts to identify patients at risk of hepatitis C infection are required. Screening efforts has to be vamped up and treatment must be prioritized to patients with elevated risk of developing advanced liver disease. Additionally, medicines must be affordable and one of the strategies used by the MOH is to negotiate with the industry for a reasonable price. The MOH is also working together with the Drugs for Neglected Diseases initiative (DNDi) to develop a new, pan-genotypic, highly tolerable, oral medication that is effective and affordable. An on-going study to prove the efficacy of a new combination of DAAs is expected to complete by September, and if the results are favourable, the regimen could be included into a public health approach to treat hepatitis C.
The MOH welcomes efforts by the Malaysian Liver Foundation (MLF), other professional bodies and pharmaceutical companies to work together to prevent hepatitis. Prevention is always better than cure.