US unlikely to reach HCV elimination goals due to low diagnoses

More than half of the estimated 2.7 million people with hepatitis C in the U.S. are unaware of their infection, which contributes to increased transmission rates and poor treatment outcomes, according to data presented at the World Hepatitis Summit 2017 in São Paulo, Brazil.

According to the researchers from the Center for Disease Analysis Foundation, Colorado, the high prevalence of people unaware of their infection status (55% nationally) means that the U.S. is very unlikely to meet either the WHO hepatitis elimination targets by 2030 or its own national targets outlined in the National Viral Hepatitis Action Plan 2017-2020.

While certain states have achieved diagnosis rates above the national estimate of 55% — including Rhode Island (60%), Ohio (61%), Louisiana (64%), California (71%), Washington (76%) and New York (81%) — the U.S. is facing the same problem with diagnosis rates that many other high-income countries.

“Despite the different levels of diagnosis across the U.S., there are also problems linking people to care,” Homie Razavi, PhD, managing director of the Center for Disease Analysis, said in a press release from the meeting. “The fact is that even when people are diagnosed, they are not being referred and often don’t get treated; there are many possible reasons for patients not accessing treatment.”

Razavi and colleagues stated that one of the reasons patients may be not be able to access treatment is due to a lack of private insurance or, in the case of two-thirds of states in the country, treatment on Medicaid programs have been restricted to those with advanced disease. Additionally, some physicians may not view treatment as a priority due to a lack of symptoms or slow disease progression and some patients may not be aware of the high cure rates achieved with direct-acting antivirals.

The other factor contributing to increasing transmission and low treatment rates is the ongoing opioid epidemic in the U.S.

“Policymakers are starkly aware of the heroin-fentanyl epidemic sweeping America,” Michael Ninburg, president elect of the World Hepatitis Alliance, said in the press release. “They also need to be aware of the resulting ballooning hepatitis C infections in certain states, most notably amongst young adults and adolescents, and be proactive about diagnosing and treating those in need.”

The researchers stated that the recent developments in new and cheaper HCV drugs, however, represents a positive step toward reaching elimination goals. For example, while Delaware previously restricted treatment on Medicaid to patients with advanced HCV progression, the lower prices of recent drugs allowed Delaware to expand Medicaid coverage.

“We have the tools to eliminate hepatitis C in the U.S.,” Ninburg concluded. “We have effective cures for hepatitis C, and also effective vaccination to prevent hepatitis B. Now we just have to make ending hepatitis a political priority and prevent hundreds of thousands of needlessly premature deaths.” – by Talitha Bennett

Reference:

Razavi H, et al. Presented at: The World Hepatitis Summit 2017; Nov. 1-3, 2017; São Paulo, Brazil.

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