We are now entering an exciting new era when new drugs for HCV are expected to be approved soon or have been approved [4]. Currently, multiple interferon-free regimens are available which can achieve SVR rates of more than 95% in 12 weeks. The simplicity of these regimens and infrequent occurrence of adverse events greatly improved adherence and ease of monitoring. However, drug-drug interactions, and adverse events can occur and the knowledge and experience of treating physicians will make a difference in the safety and effectiveness of these regimens.
Although HCV eradication is potentially feasible, there remain several barriers that need to be overcome (Table 1). The development of more potent and safer drugs may be the easiest barrier to overcome [5]. Nevertheless, the availability of regimens with 100% efficacy will have little impact given the current low detection rate. The most important barrier to overcome is the low detection rate for HCV. In the USA, less than 50% of those infected with HCV had been diagnosed, 32%-38% had been referred to care, 7%-11% had received treatment and 5%-6% achieved SVR [6].
In August 2012, the Centers for Disease Control and Prevention recommended one time testing of all individuals born between 1945 and 1965. Implementing these recommendations is estimated to diagnose 70% of HCV infected persons [7]. The benefit of increased diagnosis, however, would only be achieved, if diagnosed patients have access to care, so they can be counseled, evaluated and considered for treatment. Beyond drugs, there are other issues, such as medical expertise to evaluate liver disease and to monitor treatment. Thus, training of health care providers must go hand in hand with the implementations of screening and treatment programs. Increased public awareness of the potential sequelae of HCV infection and available options are also essential.In the United States, the overall prevalence of HCV is 1.6% with a higher prevalence among blacks, people born between 1945 and 1965, and those with a history of injection drug use [1]. Left untreated, chronic HCV infection causes liver cirrhosis, liver failure and hepatocellular carcinoma (HCC). The risk of cirrhosis is 5-30% within 20 years of infection and the risk of HCC in patients with cirrhosis is 2-4% per year. In addition to liver damage, HCV also contributes to a wide range of extra-hepatic diseases, including insulin resistance, diabetes, and glomerulonephritis. Successful treatment (SVR) had been shown to improve quality of life, reverse fibrosis, decrease HCC and reduce liver-related mortality [2, 3].
References:
- Armstrong, G.L., et al., The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med, 2006. 144(10): p. 705-14.
- Backus, L.I., et al., A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol, 2011. 9(6): p. 509-516 e1.
- Chou, R., et al., Screening for hepatitis C virus infection in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med, 2013. 158(2): p. 101-8.
- Wei, L. and A.S. Lok, Impact of new hepatitis C treatments in different regions of the world. Gastroenterology, 2014. 146(5): p. 1145-1150 e4.
- Manns, M.P. and T. von Hahn, Novel therapies for hepatitis C - one pill fits all? Nat Rev Drug Discov, 2013. 12(8): p. 595-610.
- Holmberg, S.D., et al., Hepatitis C in the United States. N Engl J Med, 2013. 368(20): p. 1859-61.
- Smith, B.D., et al., Hepatitis C virus testing of persons born during 1945-1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med, 2012. 157(11): p. 817-22.