SAN
FRANCISCO —
Despite
powerful new
medications,
the lack of
screening
and
treatment
capacity
will make it
difficult to
eliminate
the
hepatitis C
virus in the
United
States,
according to
projections
presented
here at the
Liver
Meeting
2015.
Current
trends show
that even
after 2020,
more than
500,000
people will
be unaware
that they
are infected
with
hepatitis C,
said
Jagpreet
Chhatwal,
PhD, from
the
Massachusetts
General
Hospital and
Harvard
Medical
School in
Boston.
"We need
aggressive
screening
and
treatment
policies to
further
reduce the
burden of
hepatitis C,"
he said.
The
landscape of
hepatitis C
has changed
rapidly in
the past 5
years.
Treatment
outcomes
have
advanced
with the
advent of
direct-acting
antiviral,
from a
sustained
virologic
response
rate of less
than 50%
before 2011
to better
than 95% in
2015. At the
same time,
the
Affordable
Care Act has
expanded the
number of
people with
healthcare
coverage.
To project
the course
of the
disease, Dr
Chhatwal and
his
colleagues
assessed
patient
demographics,
disease
characteristics,
therapeutics,
screening
policies,
insurance
coverage,
and access
to treatment
in the
United
States using
the
Hepatitis C
Disease
Burden
Simulation
model they
developed (Ann
Intern Med.
2014;161:170-180).
Mortality
and
Morbidity
Medications,
including
the new
direct-acting
antivirals,
will reduce
the number
of
hepatitis C
deaths by
more than
half from
2015 to
2050, Dr
Chhatwal
reported.
But if
current
trends
continue,
317,000
people will
still die
from the
virus during
that period.
In addition,
154,000
patients
with
hepatitis C
will develop
hepatocellular
carcinoma,
198,000 will
develop
decompensated
cirrhosis,
and 31,000
will undergo
liver
transplantation.
This year,
there are
2 million
noninstitutionalized
patients
chronically
infected
with
hepatitis C
and viremic,
the
researchers
estimate. Of
these,
1.1 million
are aware of
their
infection
status and
have
insurance,
but it
appears that
most of them
are still
not being
treated. On
the basis of
drug sales,
they
estimated
that only
about
140,000
patients
were treated
in 2014, and
this year,
about
180,000 will
be treated.
At this
rate, it
will take at
least 10
years before
the number
of treatment
candidates
is below
50,000, Dr
Chhatwal
reported.
"We can
treat more
than
180,000," he
told
Medscape
Medical News.
"We want to
send a
message that
if we can
increase the
number of
people
getting
treated,
then we can
reduce the
disease
burden."
He added
that the
true burden
of
hepatitis C
in the
United
States was
probably
underestimated
in this
study
because it
doesn't
include the
many people
living in
institutions.
After the
presentation,
Kenneth
Sherman, MD,
from the
University
of
Cincinnati,
said that
his own
research has
shown that
the increase
in heroin
use has led
to many
people being
infected
with
hepatitis C.
The high
rate of
infection in
immigrants
could also
affect
trends, said
session
moderator
Rajender
Reddy, MD,
from the
Hospital of
the
University
of
Pennsylvania
in
Philadelphia.
Dr Chhatwal
said he
agrees that
it would be
worthwhile
to include
data on
heroin users
and
immigrants
in future
projections.
It is
possible
that
heroin-related
infections
could
increase the
incidence of
infection,
he said.
Cost of Care
In a
separate
study, Dr
Chhatwal and
his
colleagues
estimated
that the
annual cost
of care for
patients
with
hepatitis C
grew from
$7 billion
before the
advent of
direct-acting
antivirals
to
$21 billion
in 2015.
That cost
will
decrease as
the
prevalence
of the
disease
declines,
likely down
to
$2 billion
by 2020, the
researchers
report. They
estimate,
however,
that it will
cost
$106 billion
over the
next 25
years to
make
hepatitis C
a rare
disease.
Primary care
providers
can help
reduce the
disease
burden by
screening
more
patients,
said Gyongyi
Szabo, MD,
PhD,
president of
the American
Association
of the Study
of Liver
Diseases
(AASLD).
Currently,
the Centers
for Disease
Control and
Prevention
recommends
that
everyone
born from
1945 to 1965
get tested
for
hepatitis C.
The
Institute of
Medicine is
contemplating
a study,
supported by
the AASLD,
to assess
strategies
for the
eradication
of the virus
in the
United
States, Dr
Szabo told
Medscape
Medical News.
During a
global
summit at
the Liver
Meeting,
representatives
from
hepatology
societies
around the
world and
from the
World Health
Organization
set their
sights on
drastically
reducing the
burden of
the disease,
she said.
"We agreed
that it is a
global
potential
goal for
hepatologists
to treat
hepatitis C
with the
vision of
not
necessarily
eradicating
it," said Dr
Szabo, "but
getting to
the point
where it is
a minimal
entity."
Dr Chhatwal
reports
relationships
with Merck,
Gilead, and
HEOR
Solutions.
Dr Szabo
reports
relationships
with
Conatus,
GlaxoSmithKline,
Bristol-Myers
Squibb,
Idenix,
Ideral
Integrated,
Therapeutics,
Intercept,
Johnson &
Johnson,
Novartis,
Novelos,
Ocera,
Roche,
Schering-Plough,
Vertex, and
Wyeth.
The Liver
Meeting
2015:
American
Association
for the
Study of
Liver
Diseases
(AASLD).
Abstract 104.
Presented
November 16,
2015.
