Current Hepatitis Reports

, Volume 12, Issue 4, pp 220–226

The Role of Public Health in an Era of All-Oral Therapy for Hepatitis C Infection

Hepatitis C: Therapeutics (MP Manns and T von Hahn, Section editors)

Abstract

The anticipation of all-oral therapy for hepatitis C virus (HCV) infection creates new opportunities for preventing HCV-related morbidity and mortality. This curative therapy is associated with fewer side effects and contraindications, which likely will greatly expand the number of persons eligible to receive treatment. To ensure that benefits from all-oral treatment regimens are realized for individuals and communities, public health can deliver essential services to meet its three fundamental roles: assessment, policy development, and assurance. Public health monitors HCV transmission and disease to prioritize populations needing care, and collaborates community-wide to create policies, plans, and programs to improve access to HCV testing and linkages to care. Public health also evaluates the effectiveness, accessibility, and quality of HCV care and treatment. Public health research can reveal how curative treatments can improve prevention and eliminate disparities. The extent to which public health can identify and link HCV-infected persons to quality care and appropriate therapy will be a key determining factor in whether the full benefits of curative HCV therapy are realized.

Keywords

Hepatitis viral hepatitis hepatitis C public health United States anti-viral therapy health disparities 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Jacobson I, McHutchison J, Dusheiko G, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364(25):2405–16.Google Scholar
  2. 2.
    Poordad F, McCone J, Bacon B, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364(13):1195–206.Google Scholar
  3. 3.
    Morgan RL, Baack B, Smith BD, Yartel A, Pitasi M, Falck-Ytter Y. Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: a meta-analysis of observational studies. Ann Intern Med. 2013;158(5 Pt 1):329–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Backus LI, Boothroyd DB, Phillips BR, Belperio P, Halloran J, Mole LA. A sustained virologic response reduces risk of all-cause mortality in patients with hepatitis C. Clin Gastroenterol Hepatol. 2011;9:509–16.PubMedCrossRefGoogle Scholar
  5. 5.
    McGowan CE, Monis A, Bacon BR, et al. A global view of hepatitis C: physician knowledge, opinions, and perceived barriers to care. Hepatology. 2013 Apr;57(4):1325–32.Google Scholar
  6. 6.
    Grebely J, Oser M, Taylor LE, Dore GJ. Breaking down the barriers to hepatitis C virus (HCV) treatment among individuals with HCV/HIV coinfection: action required at the system, provider, and patient levels. J Infect Dis. 2013 Mar;207 Suppl 1:S19–25.Google Scholar
  7. 7.
    McGowan CE, FriedMW. Barriers to hepatitis C treatment. Liver Int. 2012 Feb;32 Suppl 1:151–6.Google Scholar
  8. 8.
    North CS, Hong BA, Adewuyi SA, et al. Hepatitis C treatment and SVR: the gap between clinical trials and real-world treatment aspirations. Gen Hosp Psychiatry. 2013;35(2):122–8.Google Scholar
  9. 9.
    •• Holmberg SD, Spradling PR, Moorman AC, Denniston MM. Hepatitis C in the United States. N Engl J Med. 2013;368(20):1859–61. This report estimates the proportion of HCV infected persons in the United States who have been tested, received care and completed anti-viral therapy.PubMedCrossRefGoogle Scholar
  10. 10.
    Lawitz E, Mangia A, Wyles D, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013;368(20):1878–87.PubMedCrossRefGoogle Scholar
  11. 11.
    Poordad F, Lawitz E, Kowdley KV, et al. Exploratory study of oral combination antiviral therapy for hepatitis C. N Engl J Med. 2013;368(1):45–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Liang TJ, Ghany MG. Current and future therapies for hepatitis C virus infection. N Engl J Med. 2013;16;368(20):1907–17.CrossRefGoogle Scholar
  13. 13.
    Martin NK, Vickerman P, Grebely J, et al.: HCV treatment for prevention among people who inject drugs: Modeling treatment scale-up in the age of direct-acting antivirals. Hepatology 2013 [Epub ahead of print].Google Scholar
  14. 14.
    Durier N, Nguyen C, White LJ. Treatment of hepatitis C as prevention: a modeling case study in Vietnam. PLoS One. 2012;7(4):e34548.PubMedCrossRefGoogle Scholar
  15. 15.
    Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.PubMedCrossRefGoogle Scholar
  16. 16.
    Center MM, Jemal A. International trends in liver cancer incidence rates. Cancer Epidemiol Biomarkers Prev. 2011;20(11):2362–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Armstrong GL, Wasley A, Simard EP, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Chak E, Talal A, Sherman K, et al. Hepatitis C virus infection in USA: an estimate of true prevalence. Liver Int. 2011;31:1090–101.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim WR, Terrault NA, Pedersen RA, et al. Trends in waiting list registration for liver transplantation for viral hepatitis in the United States. Gastroenterology. 2009;137(5):1680–6.PubMedCrossRefGoogle Scholar
  20. 20.
    El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142(6):1264–73.PubMedCrossRefGoogle Scholar
  21. 21.
    Davis KL, Mitra D, Medjedovic J, et al. Direct economic burden of chronic hepatitis C virus in a United States managed care population. J Clin Gastroenterol. 2011;45(2):17–24.CrossRefGoogle Scholar
  22. 22.
    Rein DB, Smith BD, Wittenborn JS, et al. The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings. Ann Intern Med. 2012 Feb 21;156(4):263–70.Google Scholar
  23. 23.
    Ly K, Xing J, Klevens M, et al. The growing burden of mortality from viral hepatitis in the US, 1999–2007. Ann Intern Med. 2012;156(4):271.PubMedCrossRefGoogle Scholar
  24. 24.
    Armstrong GL, Alter MJ, McQuillan GM, et al. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology. 2000;31:777–82.PubMedCrossRefGoogle Scholar
  25. 25.
    Alter MJ. Epidemiology of hepatitis C. Hepatology. 1997;26(Suppl):62S–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Smith BD, Patel N, Beckett GA, et al.: Hepatitis C virus antibody prevalence, correlates and predictors among persons born from 1945 through 1965, United States, 1999–2008. [abstract] American Association for the Study of Liver Disease, San Francisco (CA)2011.Google Scholar
  27. 27.
    CDC: 2011 surveillance summary in pressGoogle Scholar
  28. 28.
    CDC. Hepatitis C virus infection among adolescents and young adults –Massachusetts, 2002—2009. MMWR. 2011;60(17):537–54.Google Scholar
  29. 29.
    Garg S, Taylor LE, Grasso C, Mayer KH. Prevalent and incident hepatitis C virus infection among HIV-infected men who have sex with men engaged in primary care in a Boston community health center. Clin Infect Dis. 2013;56(10):1480–7.PubMedCrossRefGoogle Scholar
  30. 30.
    CDC. Sexual transmission of hepatitis C virus among HIV-infected men who have sex with men--New York City, 2005–2010. MMWR. 2011;60(28):945–50.Google Scholar
  31. 31.
    Institute of Medicine. Committee for the Study of the Future of Public Health, Division of Health Care Services: The future of public health. Washington, DC: National Academy Press; 1988.Google Scholar
  32. 32.
    Tsui JI, Maselli J, Gonzales R. Sociodemographic trends in national ambulatory care visits for hepatitis C virus infection. Dig Dis Sci. 2009;54(12):2694–8.Google Scholar
  33. 33.
    CDC. Hepatocellular carcinoma - United States, 2001–2006. MMWR. 2010;7;59(17):517–20.Google Scholar
  34. 34.
    CDC. Testing for HCV infection: An Update of Guidance for Clinicians and Laboratorians. MMWR. 2013;62(18):362–5.Google Scholar
  35. 35.
    Kim AY, Nagami EH, Birch CE, Bowen MJ, Lauer GM, McGovern BH. A simple strategy to identify acute hepatitis C virus infection among newly incarcerated injection drug users. Hepatology. 2013;57(3):944–52.PubMedCrossRefGoogle Scholar
  36. 36.
    Macalino GE, Vlahov D, Dickinson BP, Schwartzapfel B, Rich JD. Community incidence of hepatitis B and C among reincarcerated women. Clin Infect Dis. 2005 Oct 1;41(7):998–1002.Google Scholar
  37. 37.
    •• U.S. Department of Health and Human Services. Combating the silent epidemic of viral hepatitis: action plan for the prevention, care, and treatment of viral hepatitis. Washington, DC: HHS; 2011. p. p. 1–76. Prompted by a 2010 IOM report on the state of viral hepatitis prevention in the United States, this report outlines a comprehensive approach to viral hepatitis prevention that includes strategies to improve HCV education, testing, care and treatment, surveillance, and delivery of services to populations at risk. Many action steps within this plan have been undertaken by CDC and other HHS agencies, and additional actions will soon be put forth in an updated 20142016 viral hepatitis action plan.Google Scholar
  38. 38.
    •• Institute of Medicine. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Washington, DC: The National Academies Press; 2010. In this report, IOM identified viral hepatitis as anunderappreciated health concern for the nationand recommended ways for the federal government to improve prevention of HCV transmission and disease. This report raised awareness of the silent epidemic of viral hepatitis in the United States, outlining expectations for public health policy and spurring development of a U.S. viral hepatitis action plan.Google Scholar
  39. 39.
    •• CDC. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR. 2012;61(No. RR-04)):1–18. This CDC report provides expanded recommendations for HCV testing based on evidence that persons born during 19451965 represent 81% of all persons living with HCV and three quarters of HCV-associated mortality. The U.S. Preventive Services Task Force has issued similar recommendations. These recommendations will facilitate implementation of both risk-based and birth-cohort-based strategies for HCV testing and linkage to care and treatment.Google Scholar
  40. 40.
    Moorman AC, Gordon SC, Rupp LB, et al. Baseline characteristics and mortality among people in care for chronic viral hepatitis: the chronic hepatitis cohort study. Clin Infect Dis. 2013;56(1):40–50.PubMedCrossRefGoogle Scholar
  41. 41.
    CDC. Characteristics of persons with chronic hepatic tis B—San Francisco, California, 2006. MMWR. 2007;56(18):446–8.Google Scholar
  42. 42.
    Arora S, Thornton K, Murata G, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011 Jun 9;364(23):2199–207.Google Scholar
  43. 43.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.PubMedCrossRefGoogle Scholar
  44. 44.
    Granich RM, Gilks CF, Dye C, et al. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373:48–57.PubMedCrossRefGoogle Scholar
  45. 45.
    Ruark A, Shelton JD, Halperin DT, et al. Universal voluntary HIV testing and immediate antiretroviral therapy. Lancet. 2009;373:1078.PubMedCrossRefGoogle Scholar
  46. 46.
    Wood E, Milloy MJ, Montaner JS. HIV treatment as prevention among injection drug users. Curr Opin HIV AIDS. 2012;7(2):151–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2013

Authors and Affiliations

  1. 1.Division of Viral HepatitisNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention CDCAtlantaUSA

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