Chronic infection by the hepatitis C virus (HCV) killed more than 700,000 people worldwide in 2013, mainly as a result of liver damage.[i]
Although information on the epidemiology of transmission and infection is sparse, recent estimates put the global prevalence of HCV infection at 130–150 million people.
The World Health Organization has recently initiated a global health strategy, which will run from 2016–2021, to eliminate hepatitis C as a global public health threat by 2030.
Specific targets will include reducing the number of new infections each year by 70% to around 1,000,000 and cutting the fatality rate by 60%.
In a study published in the journal Clinical Microbiology and Infection, Lanini et al.[ii] explore the global challenges ahead and the interventional strategies available to meet them successfully.
'One of the core elements of a global control programme against hepatitis C will be the new direct acting antiviral (DAA) drugs,' said senior author Giuseppe Ippolito (National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy).
'These are extremely effective, with short- duration oral treatment courses achieving cure rates in excess of 90%,' he said.
One of the core elements of a global control programme against hepatitis C will be the new direct acting antiviral (DAA) drugs
Clinical trials have now shown that a combination therapy of the nucleotide analogue inhibitors NS5B and NS5A leads to complete viral clearance in 85-100% of people with HCV.
Encouragingly, this occurs across all HCV genotypes and the access to therapy is not only for patients with advanced stage of liver disease or whether other treatments have failed due to viral resistance and other factors.
Prevention, however, is always better than cure and another major strategy will be to limit the rate of infection in healthcare settings through increased screening of donated blood for viral contamination and a substantial reduction in unsafe injections.
Data shows that these challenges arise mainly in Nigeria, Gabon, Egypt and India, but outbreaks of hepatitis C infection in Europe have occurred due to unsafe medical practices. An example of iatrogenic transmission of HVC was reported as recently as 2008 in Spain.[iii]
Beyond that, it will be vital to increase implementation of primary prevention measures. As well as improving safety in healthcare in low to middle income countries, this will also involve reducing transmission within high-risk populations in high-income countries such as intravenous drug users and prisoners.
One of the main challenges will be to ensure that those with the greatest need are targeted effectively.
'We have effective treatments in the form of DAAs but, currently, these are neither affordable or accessible in many low and middle income countries,' warned Ippolito.
'Global pressure will be required to encourage generic competition to reduce the cost of medicines and diagnostics.
'This could include direct price negotiations with the pharmaceutical companies responsible for DAA manufacture, differential pricing and voluntary licences,' he added.
[i] Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015: 386; 743-800. doi: 10.1016/S0140-6736(15)60692-4
[ii] Lanini S, Easterbook PJ, Zumla, A, Ippolito, G. Hepatitis C: Global epidemiology and strategies for control. Clinical Microbiology and Infection. 2016: doi: 10.1016/ j.cmi.2016.07.035
[iii] Martínez-Bauer, E. et al. Hospital admission is a relevant source of hepatitis C virus acquisition in Spain. J. Hepatol. 48, 20–27 (2008)