Global Timing of Hepatitis C Virus Elimination in High-income Countries

Homie Razavi; Yuri Sanchez Gonzalez; Cammy Yuen; Markus Cornberg

Disclosures

Liver International. 2020;40(3):522-529. 

In This Article

Abstract and Introduction

Abstract

Background & Aims: Introduction of highly efficacious pan-genotypic therapies for hepatitis C virus (HCV) infection has made the elimination of the disease an attainable goal. This study assessed progress made in 45 high-income countries towards meeting the World Health Organization's targets for HCV elimination by 2030.

Methods: A Markov model developed to forecast annual HCV-infected population was populated with demographic and epidemiological inputs, with historical incidence calibrated to reported prevalence of chronic HCV for each country. Future incidence was assumed to be a linear function of overall prevalence (or prevalence of minimal fibrosis in countries with treatment restrictions). 2017 levels of diagnosis and treatment were assumed constant in the future. The analysis estimated the year countries would meet HCV elimination targets for 80% reduction in incidence, 65% reduction in liver-related deaths, 90% diagnosis coverage and 80% treatment among the treatment-eligible population.

Results: Of the 45 countries analyzed, nine (Australia, France, Iceland, Italy, Japan, South Korea, Spain, Switzerland and the United Kingdom) are on track towards meeting the HCV elimination targets by 2030. While Austria, Germany and Malta could also reach the targets with expanded screening efforts, 30 countries are not projected to eliminate HCV before 2050. Incidence was the most difficult target to achieve, followed by liver-related deaths.

Conclusions: Even with introduction of curative therapies, 80% of high-income countries are not on track to meet HCV elimination targets by 2030, and 67% are off track by at least 20 years. Immediate action to improve HCV screening and treatment is needed globally to make HCV elimination attainable.

Introduction

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, including a goal to eliminate hepatitis infection as a public health threat by 2030,[1,2] and the World Health Organization (WHO) introduced global targets for the care and management of hepatitis.[1] These goals include the introduction of blood and injection safety and harm reduction programs to reduce new infections by 80%, diagnosing 90% of the hepatitis C virus (HCV)-infected population, treating 80% of the eligible population, and reducing liver-related deaths by 65% by 2030 relative to the benchmark levels in 2015.[2] Previous modelling has shown that HCV elimination by 2030 is possible at sufficiently high rates of antiviral treatment.[3] With 2020 approaching, this study assesses when high-income countries will meet the HCV elimination goals, as defined by the WHO, given the latest data on the diagnosis and treatment (including restrictions on treatment by fibrosis score) using a modelling approach.

While these goals are achievable from a clinical standpoint due to the recent availability of pan-genotypic direct-acting antivirals (DAAs) that can achieve a sustained virologic response (SVR) of more than 95% in as few as eight weeks of treatment, significant barriers remain to diagnose and treat all infected patients. Our study further explores these barriers within the context of the readiness and resources of high-income countries to achieve HCV elimination.

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