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Cure and Control: What Will It Take to Eliminate HCV?

  • Marianne Martinello
  • Behzad Hajarizadeh
  • Jason Grebely
  • Gail V. Matthews
  • Gregory J. DoreEmail author
Chapter
  • 17 Downloads
Part of the Topics in Medicinal Chemistry book series (TMC, volume 32)

Abstract

In May 2016, the World Health Organization adopted the first global hepatitis strategy, setting the ambitious goal of “elimination of viral hepatitis as a public health threat” by 2030. HCV-specific targets included a 65% reduction in HCV-related mortality and an 80% reduction in HCV incidence. Globally, an estimated 71 million people were living with chronic HCV infection in 2015. Approximately two million new HCV infections occur annually, with injecting drug use and unsafe health-care practices (including unsterile health-care injection), the predominant modes of HCV transmission.

The development and availability of highly effective direct-acting antiviral agents (DAAs) have revolutionised HCV management and provide the therapeutic tools required to strive for elimination. For HCV treatment as prevention to have greatest impact, HCV testing and treatment coverage must be high, with new diagnoses linked expediently to care and treatment. In 2015, of the 71 million people living with HCV infection, only 20% (14 million) were diagnosed, and of those diagnosed, 13% (1.1 million in 2015, 1.76 million in 2016) had initiated DAA treatment.

This chapter outlines the United Nations and World Health Organization elimination targets; defines the epidemiological concepts of control, elimination and eradication; and discusses the important lessons learnt from control and elimination efforts in other infectious diseases epidemics. The biological and technical feasibility of HCV control and elimination is discussed, followed by related financial, political and social considerations. Examples of national HCV strategies are presented, highlighting the facilitators and barriers to successful implementation of HCV elimination strategies. Control and elimination of HCV infection will require an enormous public health, political and economic commitment. The costs and risks may be high, but so too are the potential benefits.

Keywords

Diagnosis Direct-acting antiviral Elimination Hepatitis C Prevention Screening Treatment 

Notes

Acknowledgements

The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian government. The content is solely the responsibility of the authors. M.M., B.H., J.G., G.J.D. and G.V.M. are supported through National Health and Medical Research Council Fellowships (M.M and B.H., Early Career Fellowships; J.G. and G.V.M., Career Development Fellowships; G.J.D., Practitioner Fellowship).

Compliance with Ethical Standards

Funding The Kirby Institute is funded by the Australian Government Department of Health and Ageing. M.M., B.H., J.G., G.J.D. and G.V.M. are supported through National Health and Medical Research Council Fellowships (B.H., Early Career Fellowship; J.G. and G.V.M., Career Development Fellowships; G.J.D., Practitioner Fellowship).

Conflict of Interest

M.M. has received speaker payments from Abbvie. J.G. is a consultant and/or advisor and has received research grants from Abbvie, Cepheid, Gilead and Merck. G.J.D. is an advisory board member and has received honoraria from Abbvie, Bristol-Myers Squibb, Gilead, Janssen, Merck and Roche; research grant funding from Abbvie, Boeringher Ingelheim, Bristol-Myers Squibb, Gilead, Janssen, Merck, Roche and Vertex; and travel sponsorship from Bristol-Myers Squibb, Gilead, Janssen, Merck and Roche. G.V.M. has received research funding, advisory board payments and speaker payments from Gilead and research funding and speaker payments from Janssen. B.H. declares no competing interests.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG  2019

Authors and Affiliations

  • Marianne Martinello
    • 1
  • Behzad Hajarizadeh
    • 1
  • Jason Grebely
    • 1
  • Gail V. Matthews
    • 1
  • Gregory J. Dore
    • 1
    Email author
  1. 1.The Kirby Institute, University of New South WalesSydneyAustralia

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