Leaders of liver disease associations from Europe, the
United States, Latin America and Asia issued a global call to action at the
AASLD Liver Meeting this week in Boston, aiming to advance toward the goal of
eliminating hepatitis C as a public health threat.
Approximately 71 million
people worldwide have chronic hepatitis C virus (HCV), and around 1.75 million
more acquire the virus annually, according to the
American Association for the Study of Liver Diseases (AASLD), which sponsors
the conference.
In 2016, World Health Organization member states
committed
to eliminating viral hepatitis, with targets including an 80% reduction in new
hepatitis B and C infections and a 65% reduction in mortality by 2030. Studies
have shown that these
targets are achievable, but to date countries have had variable success in moving toward them.
The new statement, signed
by representatives of AASLD, the European
Association for the Study of the Liver (EASL), the Latin American Association for the Study of the Liver
(ALEH) and the Asian Pacific Association
for the Study of the Liver (APASL), calls for efforts to simplify HCV testing
and treatment in order to make them more widely available, especially in resource-limited
settings.
The
four associations, which are undertaking this initiative in partnership
with the Clinton
Health Access Initiative (CHAI), outlined four
strategies to achieve this goal:
- Simplifying diagnosis and treatment algorithms
-
Integrating hepatitis C treatment into primary care
and other disease programmes
-
Decentralising HCV services to the local level
-
Task-sharing with primary care clinicians and other
health care practitioners.
These strategies are made
possible by recent advances in the field, including rapid HCV antibody
screening and confirmatory viral load testing that can be done at a single
clinical visit, direct-acting antiviral agents (DAAs) that are highly effective
and well tolerated and, most recently, new pan-genotypic DAAs that make genotypic
testing unnecessary.
"HCV elimination is possible with country-specific
deployment and rapid scale‐up of prevention, screening and treatment
programs," AASLD said in a media statement. "Hepatologists have
key roles in expanding access to HCV care by helping non-specialists test and
treat hepatitis C, assisting government in developing sound testing and
treatment policies and working in local coalitions to address issues of testing
and treatment costs, stigma and discrimination that unnecessarily limit access
of many to life saving treatment and cure."
At a press conference launching the initiative, CHAI executive vice
president David Ripin noted that we can apply lessons learned from the global
fight against HIV, including the benefits of simplifying treatment,
decentralizing care, and working with affected communities and advocates who share
the philosophy that "patients have a fundamental right to be diagnosed and
treated." He added that it will be necessary to "focus on people who
are feeling fine and haven't even heard of hepatitis."
Michael Ninburg, president of the World Hepatitis
Alliance, stressed the importance of involving both clinicians
and patients in the initiative. "Countries do better at addressing viral
hepatitis when civil society is engaged," he said. "No one knows more
about living with a disease than the patients…Doctors and patients speak more
strongly with a united voice."
AASLD
president Michael Fried indicated that the associations plan to issue a similar
document on hepatitis B elimination by the end of next year.