Universal screening for hepatitis C virus infection should be linked to universal treatment access

Universal screening for hepatitis C - in for a penny, in for a pound

Infection with hepatitis C virus (HCV) is a major public health problem. In fact, chronic HCV is a leading cause of cirrhosis, hepatocellular carcinoma, and death from liver disease in most countries. The advent of highly effective oral direct-acting antiviral therapy is the most significant advance in the treatment of HCV in decades and now allows us to cure chronic HCV. However, a large number of infected patients have not been diagnosed since hepatitis C is a largely asymptomatic disease. Thus, it is fundamental to improve the screening system in order to identify individuals who are currently infected and to treat them. Risk-based hepatitis C testing and birth cohort screening have had limited success and many patients living with the infection are not aware of their status. Universal screening for HCV is a tremendous improvement compared with the previous strategies. Indeed, global screening leads to the appropriate identification and treatment of all individuals chronically infected with HCV and prevents the progression of liver disease and the associated morbidity and mortality. In addition, universal HCV testing appears to be cost-effective. In this article, we review the current barriers to HCV eradication and the different strategies for HCV infection screening.

Current and future strategies for the treatment of chronic hepatitis C

Chronic hepatitis C infection is a major cause of liver disease and hepatocellular carcinoma worldwide. While hepatitis C has been treated for decades with some success, the introduction of direct acting antiviral agents has revolutionized the treatment of hepatitis C with finite, highly effective, well-tolerated therapy and there are few populations that cannot be successfully treated now or are complicated to manage. The World Health Organization has released elimination targets in an effort to eliminate viral hepatitis and reduce dramatically the morbidity and mortality caused by both viral hepatitis. While hepatitis C is straightforward to treat, it remains problematic to eliminate on a global scale. Diagnosis of hepatitis C remains the major gap in the cascade of care and numerous screening strategies will be required to reduce this gap. While historically, treatment of hepatitis C has been centralized, decentralized approaches will be required to diagnose, evaluate, and link to care the large population of individuals worldwide with hepatitis C across low-, middle-, and high-income countries. With the introduction of multiple pangenotypic treatment options and reduced cost for these therapies, assessment and treatment for those with hepatitis C has been simplified and made more accessible worldwide. There are multiple populations for whom care models are being developed and refined, including those when inject drugs, those who are incarcerated, those who present with sexually transmitted disease including the men who have sex with men population, amongst many others. While a vaccine for hepatitis C remains elusive these efforts continue. Multiple successful elimination efforts have been reported.