The Global Elimination of Hep C

Professor Edward Gane from Auckland NZ gave a visionary plenary presentation on how we may be able to eradicate hepatitis C.

Background on the Hepatitis C epidemic

Global infected population consists of 80-100 million people, with about 250,000 people in Australia

The global mortality attributable to liver disease has increased 60% since 1990, making it one of the fastest rising causes of mortality. Most of this can be explained from liver cancer and cirrhosis due to hepatitis C.

Can vaccination eradicate hepatitis C?

There are many barriers to the successful development of a HCV vaccine:

1. HCV factors:

• HCV genomic diversity
• T cell exhaustion
• Impaired DC maturation
• HCV NS3/5A inhibits IFN

2. Patient factors:

• Host genomic diversity
• Aging population
• HIV co-infection

3. Other factors:

• The chimp is the only animal model for vaccine development
• Preclinical results do not translate to humans
• With new highly effective treatment, there is reduced interest in vaccine development

Can public health interventions eraticate hepatitis C?

Harm reduction strategies (needle exchange, opioid substitution programs) are moderately effective, modelling has shown that these strategies will reduce HCV prevalence in PWID by a maximum of 30% over 10 years. This is insufficient to eradicate HCV. These strategies do have other benefits, such as reductions in HIV transmission, reductions in crime and increased engagement with healthcare providers. 

Can treatment eradicate hepatitis C?

This slide demonstrates the current hepatitis C treatment cascade on the left, where about 1% of people living with hepatitis C achieve cure/SVR. If we only improve treatment with newly developed drugs, then cure rate will increase to 1.8% (middle cascade). Significantly driving up cure rates to 80% requires that 90% of people living with hepatitis C need to be diagnosed, and 90% of those diagnosed need to take up treatment.

I would think that with access to well-tolerated and highly effective hepatitis C treatment, there will be an increased drive for clinicians to test at-risk patients for hepatitis C, and there will be increased uptake of hepatitis C treatment by those who have been infected.

In Australia we are on the cusp of possibly being able to achieve a ramp-up in hepatitis C management, as the Pharmaceutical Benefits Advisory Committee (PBAC) has recommended the listing of several new hepatitis C treatments (see slide below) AND have recommended that these be available for treating people at any stage of liver disease AND that these treatments can be prescribed by general practitioners in the community, thus allowing for a large-scale rollout of hepatitis C treatment, potentially setting the scene for eradication of hepatitis C.