‘Shockingly’ low hepatitis C cure rate a decade after new treatments, CDC says

Only one in three American adults infected with the hepatitis C virus (HCV) have been cured since direct-acting antivirals became available 10 years ago, according to CDC data.

Among 1 million adults with evidence of initial infection using national HCV screening data from 2013 to 2022, only 34% had viral clearance of their infection, despite a national goal of more than 80% d elimination by 2030, reported Carolyn Wester, MD, of the CDC. National Center for the Prevention of HIV, Viral Hepatitis, STDs and Tuberculosis, and colleagues.

Additionally, only 16% of people under 40 without health insurance have been cured, Wester and his team noted in the Morbidity and Mortality Weekly Report.

“We found extremely low healing levels across the board,” Wester said during a press briefing on Thursday.

The prevalence of being cured or cured was lowest among those aged 20 to 29 (24%) and highest among those aged 60 and older (42%). People with other, unspecified, or Medicaid insurance had lower viral clearance (23%, 33%, and 31%, respectively) than those with Medicare and commercial insurance (40% and 45%, respectively). ).

Lack of diagnosis and treatment costs are both to blame, in addition to restrictive treatment coverage policies by payers, the researchers said.

In the United States, a diagnosis of HCV requires an antibody test followed by a nucleic acid test in the laboratory to confirm infection. “This process is cumbersome, causes some people to never get a confirmed diagnosis, and delays treatment,” the CDC said in a press release, adding that rapid point-of-care viral testing is needed.

Wester pointed out that “health coverage policies often make it difficult for people with hepatitis C to access treatment because of the high cost of treatment.”

“Some payers limit patients eligible for treatment or require cumbersome pre-authorization before treatment can begin, or even limit the types of providers who can prescribe treatment,” she explained. “All of these restrictions may delay or even prohibit access to this life-saving drug.”

More than 2 million people in the United States have HCV, according to CDC estimates. About 1 million of these people are unconscious and have mild symptoms, but the infection can lead to liver damage and lead to liver cancer, liver failure and death. HCV is transmitted through contact with an infected person’s blood, often through sharing needles or other equipment used to prepare and inject drugs.

“Hepatitis C is a silent killer,” Wester said. “While this study has looked at treatment gaps in people with diagnosed hepatitis C, there is also a great need for increased screening and testing.”

“Anyone with hepatitis C deserves the chance to be cured,” she added.

Although HCV can be treated with an oral direct-acting antiviral taken once daily for 8-12 weeks, resulting in a cure in most cases, “these results highlight the disproportionate need for increased access to hepatitis C treatment and prevention services in young adults,” Wester and his co-authors wrote.

At Thursday’s press conference, Francis Collins, MD, PhD, who directs the White House’s National Hepatitis C Elimination Program, noted that “the cure that’s been around for 10 years is very simple. Many many people remember the bad days when treatment for hepatitis C was very toxic and didn’t always work with interferons.”

“That is no longer the case now,” he added. “We have the tools to get a win here.”

THE National Viral Hepatitis Strategic Plan requires ≥ 80% of people with hepatitis C to achieve viral clearance by 2030. Rapid testing is an important part of achieving this goal, the researchers said. In Europe and Australia, rapid tests are already available.

“Launching this program would save the federal government more than $13 billion in the first 10 years and $44 billion over 20 years,” Collins said, adding that the cost savings would come from a reduction liver transplants and liver cancer treatment.

“It’s rare to have the opportunity to both save lives and save money at the same time, but that’s what we have here. You can’t find out and just walk away,” said he noted.

This analysis included 1,719,493 people already infected with HCV from January 2013 to December 2022. Of these people, 29% were between the ages of 20 and 39, 43% were between the ages of 40 and 59, and 27% were aged 60 and over. more ; 60% were men. About half were covered by commercial health insurance, 23% by another payer, 11% by Medicaid, 9% by an unspecified payer, and 8% by Medicare.

During this period, 88% of those already infected were classified as having undergone a viral test; of those who had a viral test, 69% were classified as having an initial infection; of those with an initial infection, 34% were classified as cured or cured (treatment-induced or spontaneous); and of these, 7% were classified as having persistent infection or reinfection.

Study results were limited to people who tested positive for HCV, Wester and his team noted.