Hepatitis C: Simplified curative treatments can drive global scale-up
13 April 2018, Paris – Access to hepatitis C curative therapy is increasing, with simplified and more affordable treatments becoming more readily available to save lives and accelerate global scale-up.
According to a WHO progress report, an estimated 1.5 million people started direct-acting antiviral (DAA) treatment in 2016, compared to around 1 million in 2015.1 Behind the impressive scale-up seen in 2016, a diverse set of countries have been leading the action. Egypt and Pakistan, two countries with the heaviest burdens of hepatitis C virus infection (HCV) in the world, accounted for half the number of people receiving HCV cure. Other countries to report progress included Australia, Brazil, China, France, Georgia, Mongolia, Morocco, Rwanda and Spain.
Despite significant progress, the overall number of people receiving HCV cure is still only around 3 million – out of a total 71 million people who require it.
"We appeal to global and national leaders to seize the incredible opportunities now available to cure all people of chronic hepatitis C and save lives," said Dr Gottfried Hirnschall, Director of the WHO Department of HIV and Global Hepatitis Programme. "Champion countries are rapidly scaling up, showing that the elimination of hepatitis C is not a pipe dream – it can and has to be done."
Major simplification of HCV treatment and its delivery to support global scale-up is now possible, according to new evidence gathered for WHO's updated treatment guidelines in development.
New, highly effective treatments, which can cure all 6 major subtypes of HCV with a success rate of over 90%, are now available.
Treatment delivery can now be simplified with the use of one-pill-a-day, fixed-dose combination drugs, which remove the need for genotyping. Previously, patients needed an expensive genotyping test before treatment, to determine which of the several different regimens could cure them.
Use of such pan-genotypic regimens can also make it easier for countries to manage procurement and supply of DAAs to accelerate scale-up efforts.
1 Progress report on access to hepatitis C treatment. WHO: March 2018
New evidence suggests that all people aged 12 or above diagnosed with chronic HCV (with the exception of pregnant women) should be offered treatment.
"Starting curative treatment earlier in all people with hepatitis C, regardless of their disease stage, can be highly beneficial," said Dr Marc Bulterys, Team Lead for the Global Hepatitis Programme. "This means they will be cured swiftly, significantly reducing the risk of liver cancer and other diseases."
Globally, around 400 000 people die of cirrhosis and liver cancer caused by untreated HCV infections every year. Cure leads to reductions of at least 87% in liver-related deaths and 80% in the risk of liver cancer due to HCV. Cure can also reduce common comorbidities among people with HCV, such as depression, diabetes and chronic renal disease.
A vast majority–an estimated 62%–of people in need of HCV curative therapy live in lowand middle-income countries that have voluntary licenses for DAAs and therefore could procure low-cost generic medicines.
WHO is reviewing this body of evidence for simplified treatment for all people living with HCV for inclusion in its upcoming HCV treatment guidelines, to be released soon.
Editor's note: WHO is organizing a symposium, "Meeting the 2030 elimination goals of the WHO viral hepatitis strategy", on 14 April 2018 at 14:00 at the International Liver Congress. The symposium will cover progress, challenges in access to HCV treatment, and new directions for the upcoming guidelines.
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