Going Viral: Why Eliminating the Burden of Hepatitis C Requires Enhanced Cooperation Between Specialists and Primary Care Providers

Excerpt

It has long been recognized that when a sustained virological response (SVR) occurs after antiviral treatment for chronic hepatitis C virus (HCV), there is a reduced risk of cirrhosis, hepatocellular carcinoma (HCC), and liver-related death [1]. During the era of peginterferon and ribavirin, achieving large-scale successful treatment of the HCV population was not an option. Yet, the introduction of the direct-acting antivirals (DAAs), that has delivered a remarkable ease-of-use and astounding success rates in actual practice as well as in clinical trials [2, 3], has impressively shifted the expectations and goals for treatment of the HCV population. Whereas in the past, few patients were ever eligible for treatment or were successfully treated [4], almost overnight the vast majority became treatment candidates with an extremely high likelihood of cure of the virus [5]. The DAAs come at a time when the previously predicted soaring rates of cirrhosis and HCC are now upon us. Death rates due to liver cancer are now increasing at the highest rate of all cancer sites [6], with the incidence of liver cancer rising second fastest of all cancer sites. The number of deaths associated with HCV is now higher than the number of deaths due to 60 other nationally notifiable infectious diseases combined [7]. At present, roughly 350,000 patients in the USA (10 % of the US HCV population) have been treated with DAAs since their introduction in late 2013 [8]; therefore, ~3 million patients in the USA remain in need of treatment. Facing the burden of long-term disease due to HCV and the effectiveness of DAA therapy, it is now widely considered as imperative to treat as many HCV patients as possible [9, 10]. …