height of more than 164,000 in 2015, the number of people treated with
direct-acting antiviral (DAA) therapy for hepatitis C has steadily declined, reaching
a low point during the COVID-19 pandemic, according to a study from the Centers
for Disease Control and Prevention (CDC) presented this week at The Liver Meeting.
"Reaching more people with hepatitis C testing
and treatment is critical to saving lives and preventing transmission of this
deadly, but curable, infection," the CDC stated in a press
The CDC estimates that around 2.4 million people in
the United States were living with hepatitis C virus (HCV) during 2013 to 2016. Over years or decades, chronic
hepatitis C can lead to serious complications including liver fibrosis,
cirrhosis and liver cancer. Most people with hepatitis C can be cured, but not
enough of them are being screened and treated, and some 40% are unaware of their
- direct-acting antiviral (DAA)
A drug which prevents hepatitis C from reproducing by blocking certain steps in its lifecycle.
Tehale of the CDC and colleagues used prescription claims data to estimate the
number and characteristics of people receiving treatment since the approval of
the first next-generation DAAs in the US at the end of 2013.
to the IQVIA prescription claims database, a total of
843,329 people initiated DAA treatment from 2014 to 2020. This is an
undercount, as the data do not include all retail, mail order and long-term
care pharmacies or the Veterans Affairs health system. About 60% were men.
Information on race/ethnicity was missing for more than two-thirds of the
cohort, but among those with available data, more than two-thirds were White, about
one in five were Black, about 10% were Latino and about 2% were Asian.
the shift in the US hepatitis C epidemic to a younger population in conjunction
with the ongoing opioid crisis, the proportion of treated people who were born
between 1945 and 1965 fell from nearly three-quarters in 2014 to less than half
in 2020. Similarly, the proportion of claims paid by commercial insurers or Medicare
(coverage for seniors) decreased over time, while claims paid by Medicaid
(coverage for low-income people) increased from 9% in 2014 to 29% in 2020.
Overall, 60% of prescribers were specialists, but as hepatitis treatment became
simpler over time, it was increasingly managed by other providers. In 2019 and
2020, about half of prescriptions were written by primary care providers, nurse
practitioners or physician assistants. In 2020, the most commonly prescribed
regimens were sofosbuvir/velpatasvir (Epclusa)
and glecaprevir/pibrentasvir (Maviret),
at about 45% each, distantly followed by sofosbuvir/ledipasvir (Harvoni).
109,000 people were treated in 2014, as DAAs availability increased. This rose
to more than 164,000 in 2015, reflecting a backlog of people awaiting simpler
and more effective treatment. Between 114,000 and 134,000 people were treated
each year from 2016 to 2019. But the number fell to approximately 84,000
in 2020, the first year of the COVID-19 pandemic.
about 120,000 people, on average, have been treated each year, this is well
below the 260,000 people the National Academies of Science and Medicine estimates would need to be treated
annually in order to eliminate hepatitis C as a public health threat by 2030.
The CDC noted that while some barriers to care have come down, new
challenges have emerged. Since 2015, many states have
removed policy restrictions that prevented people from accessing treatment, and
the cost of HCV medications have fallen thanks to competition, negotiated
discounts and innovations such as subscription models. But some state Medicaid programmes still impose barriers, including restrictions on the type of providers who can manage treatment, requirements
for sobriety and requirements for prior authorisation before treatment can
The COVID-19 pandemic has also led to major disruptions in access to
hepatitis C testing and treatment, according to the CDC. Routine healthcare
services were suspended during lockdowns, some people avoided seeking medical
care and prevention services and some syringe
service programmes – many of which offer testing and linkage to care – reduced their
At the same time, the opioid crisis continues, leading
to an increase in new hepatitis C cases. Acute HCV infections reported to CDC
quadrupled from 2009 to 2019, with the steepest rise among younger adults who
"Harm reduction programs and intervention such as
syringe services programs and substance use disorder treatment are essential to
reduce bloodborne infections, including hepatitis C, among people who inject
drugs," the CDC stated. "Connecting people who inject drugs to
hepatitis C testing and treatment services is critical to reducing hepatitis C