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Expanded screening, treatment needed to eliminate HCV in US
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An aggressive expansion in screening and treatment for hepatitis C virus infection, particularly among people who inject drugs, is necessary to eliminate the virus in the United States, according to a study published in Clinical Infectious Diseases. Findings also suggest interferon-free direct-acting antivirals will make significant reductions in HCV-associated morbidity and mortality.
“Since 2013, interferon-free direct-acting antivirals (DAAs) have been approved that feature sustained virologic response rates (SVR) greater than 90%, minimal adverse effects, reduced pill burden, and ease of oral administration,” David P. Durham, PhD, associate research scientist in epidemiology at Yale School of Public Health, and colleagues wrote. “These interferon-free DAAs have opened a new frontier in HCV treatment, raising the possibility of using treatment not only to prevent HCV-associated deaths but also to interrupt the transmission chain among [people who inject drugs (PWIDs)] and potentially eliminate HCV altogether.”
David P. Durham
Durham and colleagues created a transmission model stratified by age and injection drug use to analyze the levels of screening and treatment with noninterferon DAAs needed to curb HCV incidence in the U.S. They calibrated the model based on epidemiological data in the U.S. from 1992 to 2014. The researchers then projected the impact of DAAs at both current and enhanced screening and treatment rates through 2040, focusing on outcomes of HCV incidence, prevalence, compensated and decompensated cirrhosis, hepatocellular carcinoma, liver transplants and mortality.
For PWIDs, the researchers estimated age-specific HCV prevalence using data collected in Baltimore, Chicago, Los Angeles and New York. PWIDs were stratified into three groups — active PWIDs, temporary cessation and at-risk for relapse, and a noninjecting population.
According to the researchers, a fourfold increase in the annual number of patients treated — from the approximately 100,000 historically treated to 400,000 — is predicted to prevent 526,084 cases of cirrhosis, as well as 256,315 HCV-associated deaths. Under their model, simultaneously increasing treatment capacity while increasing the number of HCV infections diagnosed would reduce total HCV prevalence to as low as 305,599 infections by 2040. Complete elimination of HCV transmission in the U.S. through DAA treatment would require nearly universal screening of PWIDs, with an annual treatment rate of at least 30%.
“We found that HCV prevalence, HCV-associated liver disease, and HCV-associated mortality in the United States can be substantially reduced through widespread treatment with DAAs,” Durham and colleagues wrote. “Total HCV prevalence is likely to fall by more than 80% within 10 to 20 years through treatment alone. Up to 150,000 additional cases could be identified by increasing HCV screening, effectively eliminating HCV from the noninjecting population. Further opportunities exist to greatly reduce prevalence and new infections among PWIDs through targeted screening and treatment.” – by Jason Laday
Disclosure: Durham reports having consulted for and receiving research funding from Merck and Sanofi Pasteur. See the full study for a list of all other authors’ relevant financial disclosures.
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