•Advances in hepatitis C drug development will lead to high cure rates.•Access to hepatitis C treatment in low- and middle-income countries will require advocacy and public–private ...partnerships.•There is a need for low-cost HCV diagnostics that are optimized to low- and middle-income countries.•It is especially important to address people who inject drugs and prisoners.
We are entering a new era in the treatment of hepatitis C virus (HCV) infection and almost all patient groups in high-income countries have the potential to be cured with all-oral, highly potent combinations of direct-acting antiviral drugs. Soon the main barrier to curing hepatitis C, even in wealthy countries, will be the high price of these all-oral regimens. The gulf between the advances in HCV drug development and access to treatment for individual patients will be even greater in low- and middle-income countries (LMIC) where 80% of the global burden of HCV infection and mortality exists. Ensuring that people in LMIC have access to regimens against HCV will require a similar level of advocacy and public–private partnerships as has transformed the control of other global diseases such as HIV. Numerous challenges will need to be overcome. These include improving low-cost diagnostic tests, especially in sub-Saharan Africa where the false-positive rate is unacceptably high, reducing iatrogenic spread of HCV, addressing transmission among people who inject drugs (PWID), and ensuring affordable access to antiviral treatment for all people living with HCV infection in LMIC. This article forms part of a symposium in Antiviral Research on “Hepatitis C: next steps toward global eradication.”
Hepatitis C virus is a serious infection causing cirrhosis, liver cancer, and death. The recent development of direct-acting antivirals has dramatically improved tolerability of treatment and rates ...of cure. However, the high price of these medications has often limited access to care and resulted in rationing of medications in the United States to those with advanced liver disease, access to specialist care, and without active substance use. This review assesses the way pharmaceutical prices are established and how pricing of directly acting antiviral regimens in the United States has impacted access to treatment for hepatitis C virus.
Hepatitis C virus infection causes substantial morbidity and mortality, but patients with human immunodeficiency virus (HIV) co-infection are 3 times more likely to develop cirrhosis or liver ...decompensation than those infected with hepatitis C alone. Treatment of hepatitis C in patients with HIV co-infection has been limited by the reluctance of many HIV clinicians to use interferon alfa and the hesitation of many hepatologists to treat persons with HIV. Here, Graham talks about hepatitis C and HIV.
Localized US Efforts to Eliminate Hepatitis C Gaudino, Annette; Gay, Bryn; Garmon, Clifton ...
Infectious disease clinics of North America,
06/2018, Volume:
32, Issue:
2
Journal Article
Peer reviewed
The United States has national plans for the elimination of hepatitis C virus but much of US health care is organized on the state level and requires local solutions. This article describes the plans ...developed by New York, Massachusetts, and the city/county of San Francisco for hepatitis C virus elimination. Coalitions capitalize on existing resources and advocate for new resources to address barriers in hepatitis C virus care. Although each coalition has distinct plans, all share a commitment to groups that are disproportionately affected and are at risk for being excluded from advances in hepatitis C virus treatment and cure.
Hepatitis B is a serious problem in the United States (US), with up to 2.4 million Americans living with a chronic infection. Only 26-32% of people living with hepatitis B in the US are diagnosed. ...Additionally, just 30% of all adults are vaccinated against the virus. In 2022, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) updated adult hepatitis B vaccination recommendations to include all adults aged 19-59 years and those 60 years and older with risk factors for hepatitis B. Subsequently, in 2023, the CDC recommended that all adults be screened at least one time in their lives.
Electronic health record (EHR) tools (prompts, order sets, etc.) have proven to be an effective method of increasing hepatitis B screening and vaccination, but longstanding challenges and questions around hepatitis B vaccines and tests could prevent effectual EHR implementation. As the new recommendations directly impact providers who may have limited familiarity with hepatitis B, guidance on how to identify eligible patients and triggers, order sets to facilitate vaccine/test selection, and proper documentation and patient follow-up is necessary.
This communication offers a practical framework for health systems to build an effective EHR strategy for the updated adult hepatitis B recommendations. We also provide comprehensive responses to clinicians' questions that are frequently asked prior to screening or vaccinating for hepatitis B.
...gaps in physician knowledge may result in inappropriate or less effective screening in primary care settings. Since the implementation of tissue and blood product HCV testing, the risk of HCV ...infection from a blood transfusion in the US has decreased from 33% to <0.1%, essentially eliminating a major risk that impacted the baby-boomer cohort. ...exclusion of HCV Ab testing from the diagnostic algorithm would have no adverse impact on patient care since individuals who experience spontaneous viral clearance are not at risk for HCV-driven disease progression. For now, genotyping is recommended about 12 weeks before planned treatment initiation, to guide therapy. Because mixed genotypes may be detected with careful study, and because increasingly potent regimens are becoming available, genotype assignment may not be necessary in the long term. The decision to genotype is dependent purely on intention to treat because outcomes of chronic infection for different HCV types do not vary significantly. ...HCV genotyping can be performed as part of a reflex panel that includes antibody and RNA testing if immediate treatment is anticipated, or it can be delayed until the time oftreatment.
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