North Shore Gastroenterology, in partnership with NEOLA (Northeast Ohio Liver Alliance), is committed to the National HCV Elimination Program goal of eliminating Hepatitis C by the year 2030. North Shore’s team is dedicated to this mission and looks forward to partnering with primary care providers, community leaders, public health experts, and educators throughout Northeast Ohio to fulfill this objective. The most recent article titled The national hepatitis C Elimination program-AASLDs Coalition outlines the details of the program and the efforts being put forth.
A 64-year-old woman presented to the liver clinic. She had known of her diagnosis of chronic hepatitis C for “years” but had not been treated owing to treatment restrictions in the states where she had lived and periods of being uninsured. At evaluation, she had cirrhosis, and unfortunately, imaging showed several liver masses, consistent with multifocal hepatocellular carcinoma (HCC), beyond the criteria eligible for liver transplantation. In the months that followed, she was cured of her hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs). Yet, her life will almost certainly be shortened by having been infected with HCV and we are left knowing that this could have been prevented if only she had been treated years earlier. Her journey highlights the urgent and critical importance of identifying, relinking, and treating those living with HCV.
Global progress toward HCV elimination by 2030 is not on track in many countries,1 including the United States. However, countries with fewer resources (e.g., Georgia and Egypt) that have implemented plans for universal HCV screening and treatment are on track, highlighting the importance of national policies in achieving elimination goals. Now, the United States has a bold plan to achieve elimination with a “National HCV Elimination Program” proposed in the fiscal year 2024 White House budget. Finally, the United States, a giant of HCV research and discovery, will step forward with action to prevent any further loss of life due to HCV and to halt the rising healthcare costs related to HCV and its complications if Congress adopts this plan. In this context, the American Association for the Study of Liver Diseases (AASLD) is reaching out to its members, its collaborators, and its partners in clinical care, public health, research, education, and advocacy to take action and support this transformative initiative.
Thousands of Americans succumb to chronic HCV annually in the United States, and rates of acute HCV are rising coincident with the ongoing opioid epidemic.2 And yet, an all-oral curative therapy has been available since 2016, is easily tolerated, and cures almost 100% of patients in 8–12 weeks.3 Treatment with DAAs reduces the risk of transmission to others, a critical component of the prevention of new infections. Importantly, HCV cure is associated with improved liver-related outcomes—lower rates of cirrhosis, liver decompensation, liver cancer, and the need for liver transplantation. Less appreciated but relevant is the association of HCV infection with a range of extrahepatic manifestations including mixed cryoglobulinemia, type 2 diabetes mellitus, chronic kidney disease, and others.4 Cure of HCV is associated with reduced rates of these complications. Finally, DAA treatment is also an effective cancer-prevention strategy. Curing HCV with DAAs can reduce the risk of not only liver cancer but also non-hepatocellular malignancies such as selected types of B-cell non-Hodgkin lymphoma.4,5 These benefits provide the rationale for identifying and treating every person living with HCV. Modeling of the National Hepatitis C Elimination Program shows that within 5 years of implementation, 92.5% of all persons with HCV will be diagnosed and 89.6% of those with HCV infection will be cured. Over 10 years, compared with the status quo, this initiative will avert 20,000 cases of HCC, 49,100 cases of diabetes, and 25,000 cases of chronic kidney disease. With this disease prevention, the initiative will avert 24,000 deaths adding 220,000 life-years. These benefits in improved health will save $18.1 billion in direct healthcare spending, of which $13.3 billion would accrue to the federal government. Over 20 years, the health benefits would increase by more than 2-fold and cost savings by 3-fold.6
The COVID-19 pandemic significantly disrupted HCV care delivery in the United States, leading to marked reductions in testing and treatment, particularly during the pandemic’s early phase.7 Yet as we recover from these initial setbacks, there is an opportunity to learn from the public health response to the pandemic to reimagine what is possible in addressing HCV with sufficient resources and resolve. The rapidity with which COVID-19 point-of-care tests became available and widely used, surveillance dashboards were built, and novel therapeutics and vaccines were developed and distributed was unprecedented. We need to leverage the medical innovations and public health infrastructure established to address COVID-19 to assist in HCV elimination. Indeed, the success of the SARS-CoV-2 vaccine in addressing the pandemic highlights the critical importance of HCV vaccine development in achieving elimination, with a preventative vaccine being the surest means of reducing new HCV infections.
What is the contribution of the AASLD and specialists in the National Hepatitis C Elimination Program? Multiple opportunities are available—as capacity builders, educators, treatment givers, advocacy champions, and researchers (Figure 1). Specialists will need to be engaged in each pillar of the National Hepatitis C Elimination Program for success to be achieved. Elimination of this lethal disease in the United States is within reach, but a concerted response from specialists, primary care providers, and public health workers will be required to achieve elimination.