Strategies for the Elimination of Hepatitis C Virus Infection as a Public Health Threat in the United States
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Purpose of Review
Direct-acting antiviral regimens for chronic hepatitis C virus (HCV) infection became available in 2014, and these highly curative therapies have the potential to reduce HCV-associated morbidity and mortality, decrease HCV transmission, and eliminate HCV infection as a public health problem. This review summarizes the recommendations by the National Academies of Sciences, Engineering, and Medicine for a US strategy for HCV elimination.
To achieve proposed targets of reducing HCV incidence by 90% and decreasing HCV-related mortality by 60% by 2030, there is a critical need to improve HCV diagnosis and linkage to care, reduce HCV-related disease by antiviral treatment scale-up, reduce HCV incidence, and strengthen HCV surveillance to determine achievement of HCV elimination targets over time.
While HCV elimination is feasible, success of this national effort will require ongoing collaboration and critical resource investment by key stakeholders, including medical and public health communities, legislators, community organizers, and patient advocates.
KeywordsHepatitis C Elimination US public health threats
Compliance with Ethical Standards
Conflict of Interest
Charitha Gowda declares no conflicts of interest.
Vincent Lo Re reports grants from AstraZeneca and reports having served on the committee convened by the National Academies of Sciences, Engineering, and Medicine to outline a national strategy for HCV elimination, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM, et al. Chronic hepatitis C virus infection in the United States, national health and nutrition examination survey 2003 to 2010. Ann Intern Med. 2014;160(5):293–300. https://doi.org/10.7326/M13-1133.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.• Pawlotsky JM. New hepatitis C therapies: the toolbox, strategies, and challenges. Gastroenterology. 2014;146(5):1176–92. https://doi.org/10.1053/j.gastro.2014.03.003. Important initial review summarizing the development of direct-acting antiviral agents and interferon-sparing treatment strategies for chronic HCV infection. CrossRefPubMedGoogle Scholar
- 6.World Health Organization. Combating hepatitis B and C to reach elimination by 2030. http://apps.who.int/iris/bitstream/10665/206453/1/WHO_HIV_2016.04_eng.pdf?ua=1. Accessed 24 Oct 2017.
- 7.Department of Health and Human Services. The U.S. national viral hepatitis action plan for 2017–2020. https://www.hhs.gov/sites/default/files/National%20Viral%20Hepatitis%20Action%20Plan%202017-2020.pdf. Accessed 24 Oct 2017.
- 8.•• National Academies of Sciences Engineering, and Medicine. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase one report, Washington (DC): The National Academies Press; 2016. Formative Phase One report published by the National Academies to first evaluate and describe the feasibility of a national strategy for the elimination of HCV in the US. Google Scholar
- 9.•• National Academies of Sciences EaM. In: Strom BL, Buckley GJ, editors. A National Strategy for the elimination of hepatitis B and C: phase two report. Washington (DC): The National Academies Press; 2017. Seminal phase two report published by the National Academies that provides clear recommendations for achievement of US HCV elimination targets by 2030. Google Scholar
- 11.Moyer VA, USPSTF. Screening for hepatitis C virus infection in adults: U.S. preventive services task force (USPSTF) recommendation statement. Ann Intern Med. 2013;159(5):349–57. https://doi.org/10.7326/0003-4819-159-5-201309030-00672. CrossRefPubMedGoogle Scholar
- 12.• Yehia BR, Schranz AJ, Umscheid CA, Lo Re V 3rd. The treatment cascade for chronic hepatitis C virus infection in the United States: a systematic review and meta-analysis. PLoS One. 2014;9(7):e101554. https://doi.org/10.1371/journal.pone.0101554. Important systematic review that depicts the care continuum for HCV infection in the US. CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Hsieh YH, Rothman RE, Laeyendecker OB, Kelen GD, Avornu A, Patel EU, et al. Evaluation of the Centers for Disease Control and Prevention recommendations for hepatitis C virus testing in an urban emergency department. Clin Infect Dis. 2016;62(9):1059–65. https://doi.org/10.1093/cid/ciw074.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Trooskin SB, Poceta J, Towey CM, Yolken A, Rose JS, Luqman NL, et al. Results from a geographically focused, community-based HCV screening, linkage-to-care and patient navigation program. J Gen Intern Med. 2015;30(7):950–7. https://doi.org/10.1007/s11606-015-3209-6.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Irvin R, McAdams-Mahmoud A, Hickman D, Wilson J, Fenwick W, Chen I, et al. Building a community—academic partnership to enhance hepatitis C virus screening. J Community Med Health Educ. 2016;6(3) https://doi.org/10.4172/2161-0711.1000431.
- 20.Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Recomm Rep. 1998;47(RR-19):1–39.Google Scholar
- 22.Centers for Disease Control and Prevention. Locations and reasons for initial testing for hepatitis C infection—chronic hepatitis cohort study, United States, 2006–2010. MMWR Morb Mortal Wkly Rep. 2013;62(32):645–8.Google Scholar
- 23.Centers for Disease Control and Prevention. Guidelines for viral hepatitis surveillance and case management. Atlanta, GA. 2005. https://www.cdc.gov/hepatitis/pdfs/2005guidlines-surv-casemngmt.pdf. Accessed 31 July 2017.
- 24.Centers for Disease Control and Prevention. Epidemiology and laboratory capacity for infectious diseases (ELC) cooperative agreement. https://www.cdc.gov/ncezid/dpei/epidemiology-laboratory-capacity.html. Accessed 22 Oct 2017.
- 25.Klompas M, Murphy M, Lankiewicz J, McVetta J, Lazarus R, Eggleston E, et al. Harnessing electronic health records for public health surveillance. Online J Public Health Inform. 2011;3(3) https://doi.org/10.5210/ojphi.v3i3.3794.
- 32.Maurer KG, Gondles EF. Hepatitis C in correctional settings: challenges and opportunities. Coalition of Correctional Health Authorities and American Correctional Association 2015;2(1):1–15.Google Scholar
- 33.Liu S, Watcha D, Holodniy M, Goldhaber-Fiebert JD. Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis. Ann Intern Med. 2014;161(8):546–53. https://doi.org/10.7326/M14-0602.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Wills T, Friedrich M, Beal J, Somboonwit C, Mcintosh S, Bork A et al. Implementing hepatitis C treatment programs in comprehensive HIV clinics: the Health Resources and Services Administration (HRSA) special projects of national significance hepatitis C treatment exapnsion initiative. ID Week 2014; October 10, 2014; Philadelphia. [Abstract PA2014].Google Scholar
- 46.•• American Association for the Study of Liver Diseases/Infectious Diseases Society of America. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed 10 Aug 2017. Important evidence-based consensus guidelines issued by major specialty societies providing guidance for clinicians on up-to-date care and management of chronic HCV infection.
- 50.Martin NK, Thornton A, Hickman M, Sabin C, Nelson M, Cooke GS, et al. Can hepatitis C virus (HCV) direct-acting antiviral treatment as prevention reverse the HCV epidemic among men who have sex with men in the United Kingdom? Epidemiological and modeling insights. Clin Infect Dis. 2016;62(9):1072–80. https://doi.org/10.1093/cid/ciw075.CrossRefPubMedPubMedCentralGoogle Scholar
- 51.Backus LI, Belperio PS, Shahoumian TA, Mole LA. Impact of sustained virologic response with direct-acting antiviral treatment on mortality in patients with advanced liver disease. Hepatology. 2017; https://doi.org/10.1002/hep.29408.
- 53.van der Meer AJ, Veldt BJ, Feld JJ, Wedemeyer H, Dufour JF, Lammert F, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308(24):2584–93. https://doi.org/10.1001/jama.2012.144878.CrossRefPubMedGoogle Scholar
- 56.Chahal HS, Marseille EA, Tice JA, Pearson SD, Ollendorf DA, Fox RK, et al. Comparative clinical effectiveness and value of novel interferon-free combination therapy for hepatitis C genotype 1: summary of California technology assessment forum report. JAMA Intern Med. 2015;175(9):1559–60. https://doi.org/10.1001/jamainternmed.2015.3348.CrossRefPubMedGoogle Scholar
- 59.Health Resources and Services Administration (HRSA). 340B drug pricing program http://www.hrsa.gov/opa. Accessed 10 Aug 2017.
- 60.• Grebely J, Dore GJ, Morin S, Rockstroh JK, Klein MB. Elimination of HCV as a public health concern among people who inject drugs by 2030—what will it take to get there? J Int AIDS Soc. 2017;20(1):1–8. https://doi.org/10.7448/IAS.20.1.22146. Important review describing specific challenges and proposed solutions to achieve HCV elimination among people who inject drugs (PWID), a group with the highest HCV prevalence. CrossRefGoogle Scholar
- 61.Perlman DC, Jordan AE, Uuskula A, Huong DT, Masson CL, Schackman BR, et al. An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: structural barriers and public health potential. Int J Drug Policy. 2015;26(11):1056–63. https://doi.org/10.1016/j.drugpo.2015.04.015.CrossRefPubMedPubMedCentralGoogle Scholar
- 62.Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, et al. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav. 2013;17(9):2878–92. https://doi.org/10.1007/s10461-013-0593-y.CrossRefPubMedGoogle Scholar
- 64.Holtzman D, Barry V, Ouellet LJ, Des Jarlais DC, Vlahov D, Golub ET, et al. The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994–2004. Prev Med. 2009;49(1):68–73. https://doi.org/10.1016/j.ypmed.2009.04.014. CrossRefPubMedGoogle Scholar
- 66.Van Den Berg C, Smit C, Van Brussel G, Coutinho R, Prins M, Amsterdam C. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam cohort studies among drug users. Addiction. 2007;102(9):1454–62. https://doi.org/10.1111/j.1360-0443.2007.01912.x.CrossRefGoogle Scholar
- 68.Centers for Disease Control and Prevention. Syringe exchange programs—United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(45):1488–91.Google Scholar
- 70.Oramasionwu CU, Johnson TL, Zule WA, Carda-Auten J, Golin CE. Using pharmacies in a structural intervention to distribute low dead space syringes to reduce HIV and HCV transmission in people who inject drugs. Am J Public Health. 2015;105(6):1066–71. https://doi.org/10.2105/AJPH.2015.302581.CrossRefPubMedPubMedCentralGoogle Scholar
- 72.Midgard H, Hajarizadeh B, Cunningham EB, Conway B, Backmund M, Bruggmann P, et al. Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: the ACTIVATE study. Int J Drug Policy. 2017;47:230–8. https://doi.org/10.1016/j.drugpo.2017.05.040. CrossRefPubMedGoogle Scholar
- 73.Turner KM, Hutchinson S, Vickerman P, Hope V, Craine N, Palmateer N, et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 2011;106(11):1978–88. https://doi.org/10.1111/j.1360-0443.2011.03515.x.CrossRefPubMedGoogle Scholar
- 74.Palmateer NE, Taylor A, Goldberg DJ, Munro A, Aitken C, Shepherd SJ, et al. Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions. PLoS One. 2014;9(8):e104515. https://doi.org/10.1371/journal.pone.0104515.CrossRefPubMedPubMedCentralGoogle Scholar
- 82.Office of National AIDS Policy. https://www.whitehouse.gov/onap. Accessed 23 Oct 2017.