The HCV Rooster Has Come Home to Roost

Written by Jose M Zuniga, Other, 09:50AM Feb 29, 2012

I wrote in a previous AIDScan blog about how hepatitis C virus (HCV) infection was expected to become a much larger public health problem as "baby boomers" begin to succumb to the disease. That prediction was borne out this week as research published in the Annals of Internal Medicine announced that HCV-related deaths in the United States now exceed HIV-related deaths, with an upward trend in HCV-related mortality, much of it attributed to individuals aged 45 to 64 years.¹ Equally alarming are data from a separate study also published in the Annals of Internal Medicine revealing that the majority of HCV infections in the United States are undiagnosed.²

These two papers reinforce the need to fully implement the US Department of Health and Human Services' "Action Plan for Prevention, Care, and Treatment of Viral Hepatitis," which calls for, among other things, an increase in targeted HCV screening of individuals born between 1945 and 1965.³ As the authors of the latter paper conclude, birth-cohort screening linked to HCV treatment with pegylated-interferon (PEG-IFN) and ribavirin (RBV) - which, incidentally, has been replaced with an even more therapeutically effective standard of care (see next paragraph) - might help significantly reduce HCV-related deaths versus current risk-based screening.²

In relation to HCV treatment, a new class of protease inhibitors - direct-acting antivirals (DAAs)-prescribed in combination with PEG-IFN and RBV, continues to demonstrate impressive cure rates. The HCV pipeline seems equally robust, with several more treatment options on the horizon, including potentially IFN-sparing options that will simplify dosing and address side effect concerns.

The bottlenecks to expanding access to HCV treatment, however, include both gaps in screening and diagnosis capacity, and in the numbers of clinicians able to prescribe the new standard of care for HCV infection. This, too, requires our immediate attention as well as a common understanding across medical disciplines, professions, and specialties that the needs of HCV-positive individuals require collaboration at practitioner-, clinic-, and health system-levels.

SHAMELESS PLUG WARNING: All of the issues discussed above will be addressed at the 2nd International Conference on Viral Hepatitis, March 26-27, 2012, at the New York Academy of Medicine in New York City. Visit www.iapac.org to view the program, faculty roster, and/or to register online.

1. Ly KN, Xing J, Klevens M, et al. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;156:271-278.
2. 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;156:263-260.
3. DHHS. Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis. 2011, US Department of Health and Human Services, Washington, DC, USA.

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