Committee presents guideline for eliminating HBV, HCV in the US by 2030

The National Academies of Science, Engineering and Medicine released phase two of its report outlining a strategy for eliminating viral hepatitis in the United States by 2030 and potentially saving 90,000 lives.

“Viral hepatitis is simply not a sufficient priority in the United States,” Brian L. Strom, MD, MPH, chair of the committee and chancellor and university professor, Rutgers Biomedical and Sciences, Rutgers University, Newark, said in a press release. “Despite being the seventh leading cause of death in the world — and killing more people every year than HIV, road traffic accidents or diabetes — viral hepatitis accounts for less than 1% of the National Institutes of Health research budget.”

The CDC and HHS, AASLD, the Infectious Diseases Society of America (IDSA) and the National Viral Hepatitis Roundtable sponsored the report. The report consists of five strategic directions for the potential elimination of viral hepatitis in the United States and accompanying recommendations. Phase one of the report identified the feasibility of viral hepatitis elimination in the United States.

“Due to recent technological advances, we now have a unique opportunity to eliminate these terrible and underappreciated diseases as public health problems,” Strom told Healio.com/Hepatology. “This report gives a roadmap of how to accomplish that.”

Collecting data

Eliminating viral hepatitis in the United States will require accurate measurement of the hepatitis disease burden. Standardized screening, follow-up, monitoring and linkage to care of all viral hepatitis cases reported through public health surveillance as well as understanding the epidemiology of viral hepatitis in high-risk populations are necessary.

The committee recommends that the CDC partner with state and local health departments to standardize health care, work with the National Cancer Institute to attach viral etiology to reports of liver cancer in its periodic national reports, and support cross-sectional and cohort studies in high-risk populations.

Interventions

Necessary interventions include expanded access to adult HBV vaccination, early testing for HBV viremia to help determine the best course of treatment for pregnant women who are HBsAg-positive, expanded access to syringe exchange and opioid agonist therapy for high-risk patients, and eliminating restrictions that are not medically indicated for the use of direct-acting antivirals for all chronic HCV patients.

While increased screening could put a burden on the health care system, any measure that sheds light on the subclinical burden on HBV and HCV infection would benefit society and aid in the elimination of viral hepatitis, according to the committee.

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Providing service

Undiagnosed and untreated patient populations include those who are unable to see a specialist, incarcerated patients, and high-risk patients such as injection drug users and those on the scale of the Ryan White System.

Recommendations in the report include: the National Committee for Quality Assurance should establish measures to monitor compliance with viral hepatitis screening guidelines and include those new measures in the Healthcare Effectiveness Data and Information Set; AALSD and IDSA should partner with primary care providers and their professional organizations to develop a referral system for medically complex patients; the HHS should work with states to build a comprehensive system of care and support for special populations; and the criminal justice system should screen, vaccinate and treat patients in correctional facilities with viral hepatitis.

Eliminating financial barriers

DAAs are responsible for a significant decrease in HCV cases, but they are expensive. As none of the approved DAAs will come off patent before 2029, inability to access this treatment may result in tens of thousands of deaths and billions of dollars wasted in medical costs, according to the report. The committee recommends that the federal government on behalf of HHS should purchase the rights to DAAs for use in neglected market segments, such as Medicaid, the Indian Health Service and prisons. This could be done through the licensing or assigning of a patent in a voluntary transaction with an innovator pharmaceutical company, according to the report.

Research

Further research into immune response and curative therapies for chronic HBV and HCV would aid the goal of eliminating viral hepatitis in the United States by 2030. Additionally, stigma alleviation is needed regarding high-risk patients and attention is required for incarcerated patients.

“Elimination of hepatitis B and C as U.S. public health problems is possible if the strategy outlined in the committee’s report were implemented. Improvements in testing, diagnosis, and care, as well as increased preventive measures and focused research, are possible, but they will require the cooperation of various federal and state government agencies, professional societies, legislators and private sector organizations,” the committee wrote in a highlight of the report. “The committee provides a path toward mitigating these problems, avoiding about 90,000 deaths by 2030.” – by Talitha Bennett

Reference: National Academies of Sciences, Engineering, and Medicine. 2017. A national strategy for the elimination of hepatitis B and C: Phase two report. Washington, DC: The National Academies Press.

Disclosure: Healio.com/Hepatology was unable to determine the committee members’ relevant financial disclosures at the time of publication.