What Is Needed to Eliminate Hepatitis C Virus in the US?

A recent report suggests that when it comes to eliminating hepatitis C virus (HCV), surveillance and monitoring efforts are imperative; in fact, even modest investments have the potential to improve lives and save money.

HCV treatment has “evolved substantially,” according to the Centers for Disease Control and Prevention, since “highly effective HVC protease inhibitor therapies” were first introduced in 2011. Now, effective medicines are available to treat, and often cure the virus. The success of these drugs have contributed to a growing consensus that the virus can be wiped out as a global health threat.

However, healthcare personnel lack information on how to deploy resources to prevent new infections, screen and diagnose cases, and treat those living with the disease, according to the O'Neill Institute for National and Global Health Law at Georgetown University in Washington, DC.

"Most of the newly infected HCV cases are among injection opioid drug users,” noted co-author and institute associate Sonia L. Canzater, JD, MPH. “But we often do not have even basic information to adequately monitor where and how the HCV epidemic is unfolding in the US, and we are not using the clinical data that is already collected."

Dr. Canzater identified five priorities for monitoring HCV with fellow author Jeffrey S. Crowley, MPH, who is the institute’s program director of infectious disease initiatives. The suggested steps are:

1. Expand and standardize reporting to the CDC
2. Use electronic medical records to collect data
3. Fund research employing clinical data sets
4. Integrate HCV monitoring with responses to the opioid epidemic
5. Establish hepatitis C elimination plans across major US health systems

At least 3.5 million Americans are infected with HCV. The CDC reports that rates of new infections have increased nearly 2.9-fold between 2010 and 2015.

While 3 out of 4 Americans living with HCV are “Baby Boomers,” born between 1945 and 1965, young adults aged 20 to 39 account for the highest rate of new cases, according to the report.

"Even with a constrained federal budget, more resources are needed for HCV surveillance and monitoring," Dr. Crowley said. "Relatively modest investments, however, can have a big impact toward eliminating HCV."

The authors estimate that wiping out the virus would drastically cut liver cancer rates. HCV elimination would also save almost $300 million a year in healthcare costs because it would help patients avoid liver transplant surgeries.

Dr. Canzater and Dr. Crowley wrote the report after consulting with hepatitis C medical and non-medical providers, patient advocates, epidemiologists, and federal HCV policy and program staff. Gilead Sciences Inc, a Foster City, CA, maker of direct-acting antiviral (DAA) drugs that target hepatitis C, provided a grant to support the project.

"Unlike some pressing problems where the scope of need is so large it can be immobilizing, modest new investments can have a significant impact,” the authors conclude. “Boosting the capacity to monitor the HCV epidemic can move the nation toward eliminating HCV as a public health threat in the United States."