Viral hepatitis eradication ambitious but becoming achievable
Eradication of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is becoming achievable, although much work still has to be done, says an expert.
“The WHO has set ambitious global targets to control viral hepatitis. By 2030, the incidence of chronic HBV and HCV infection should be reduced by 90 percent, 80 percent of treatment-eligible patients should be on treatment, and hepatitis B- and C-related deaths should be reduced by 65 percent,” explained Professor Ed Gane of the University of Auckland, Auckland, New Zealand. [http://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/]
“Indeed, HCV infection may become the first infectious disease to be eradicated in human history through widespread use of specific antimicrobial therapy,” he said. “In the past 20 years, treatment for chronic HCV infection has evolved from 48 weeks of interferon with cure rates below 25 percent, to 8 weeks of direct-acting antiviral [DAA] combination therapies with cure rates of almost 100 percent.”
Global elimination of a disease should begin with micro-elimination in a defined subpopulation or geographic area. [J Hepatol 2017;67:665-666] “Micro-elimination of HCV infection should start from specific high-risk groups. HCV-infected liver transplant recipients, for example, can be easily identified and treated accordingly,” noted Gane.
“Eliminating HCV from a country has also become a reality. In New Zealand, for example, HCV treatment uptake has increased by nearly 20-fold after the approval of funding for ombitasvir/paritaprevir/ritonavir/dasabuvir and ledipasvir/sofosbuvir fixed-dose combinations last year. After that, treatment uptake has been decreasing, suggesting that the most easy-to-reach patients have been treated and cured,” he pointed out. “Our next step is to identify undiagnosed patients as well as those who are lost to follow-up. Meanwhile, the government should also permit community prescription of HCV treatment, provide affordable treatment, and remove stigma attached to HCV infection to help eliminate the disease from the country.”
“The pangenotypic sofosbuvir/velpatasvir and glecaprevir/pibrentasvir fixed-dose combination regimens require no genotyping or on-treatment monitoring, and are therefore ideal for HCV treatment in primary care settings,” suggested Gane.
However, a lot of obstacles remain along the road to global HCV eradication.
“Globally, much work has to be done to minimize HCV transmission via iatrogenic means and needle exchange among individuals who inject drugs,” pointed out Gane. “Despite the availability of effective therapy, almost 80 percent of patients with HCV infection do not receive treatment after diagnosis, primarily due to cost and access issues.”
“Eradication of HBV is also possible, although this will take a much longer time to achieve,” he noted.
“Neonatal vaccination has been a very effective means in this context. In China, the prevalence of childhood HBV infection was reduced by 90 percent within 20 years after the introduction of neonatal vaccination in 1992,” he said. [Vaccine 2009;27:6550-6557]
“However, life-long antiviral therapy is still required in HBV-infected individuals,” he continued. “On a positive note, novel strategies are being developed to offer curative treatment with a finite treatment duration to benefit these patients and reduce the enormous healthcare burden of HBV infection.”