Just as the development of highly active antiretroviral therapy spurred advocacy and finally action to extend treatment to people living with HIV in developing countries, the development of new direct acting antivirals that can cure the vast majority of patients with chronic hepatitis C infection has evoked a call to extend prevention and curative therapy to the millions living with the virus worldwide. As with HIV, most of these individuals do not know they are infected and live in low- or middle-income countries.
“We have powerful tools in hand and it is time to talk about the elimination of hepatitis B and C as public health problems,” said Gottfried Hirnschall of the World Health Organization at a session here Tuesday. WHO is developing a hepatitis elimination strategy to be released later this year at the World Health Assembly with targets to reduce rates of hepatitis caused deaths and new infections, Hirnshall said.
China, Pakistan, Nigeria, Egypt and India account for an estimated half of the up to 180 million hepatitis C infections worldwide, a global landscape of the the virus presented by Dr. Imad Waked of the National Liver Institute in Cairo showed. Across the world three to four million new infections occur annually.
While injection drug use drives the hepatitis C epidemic in the U.S., in most countries unsafe injections in healthcare contexts fuel the spread of the virus, which can survive 72 hours on surfaces and as long as 8 weeks in syringes and swabs. Clean needles alone don’t address the risks because of the contamination of drug preparation equipment. Tragically, decades-long treatment campaigns for schistosomiasis in Egypt and vaccine campaigns in urban Cameroon generated high burdens of hepatitis C in these countries.
Egypt, where 35,000 people die from HCV related complications each year, has negotiated the best prices for treatment currently available in the world — about $1,000 for a course of treatment— and has embarked on a major campaign to treat its population, but the new treatments remain unavailable across the rest of the continent.
About 70 percent of people infected with HCV develop chronic disease. In the context of HIV, especially in high HIV burden countries like Nigeria, rates of chronic infection are higher, as are, viral loads. Rates of post-treatment reinfection among people with HIV are as much as 20 times higher than among those without HIV infection.
If affordably accessed, the new treatments could change all of that.
Direct acting antivirals, Waked noted, hold the promise of having Hepatitis C be “the first chronic viral infection to be eliminated with treatment.”