Novel antiviral therapies for hepatitis C could reduce the prevalence of the blood-borne infection by more than 80 percent, an analysis by researchers at the Yale School of Public Health has found. The discovery raises the possibility of greatly reducing — and even eliminating — the life-threatening infection in the United States if enhanced screening and treatment efforts target high-risk populations.
The study published online December 1 in the journal Clinical Infectious Diseases.
Recently approved direct-acting antiviral medications have transformed treatment for individuals with hepatitis C virus (HCV), and are effective in over 90 percent of cases. The antivirals have the potential to significantly reduce or eliminate HCV in two ways: through treatment to prevent HCV-related complications and deaths, and by preventing further transmission among injection-drug users.
To study the effects of the new treatments on the U.S. population, the Yale team developed a transmission model to predict the effect of treatment with direct-acting antivirals over time. They also quantified the impact of use of the antivirals at current and at enhanced screening and treatment rates. Their analysis included outcomes such as cirrhosis, liver transplants and mortality.
“The key finding is that a four-fold increase to the number of patients treated each year could virtually eliminate HCV from the non-injecting population within a decade,” said Dr. Jeffrey Townsend, associate professor at the School of Public Health and senior author of the study. More modest increases in screening and treatment would also markedly reduce new infections and mortality, Townsend and co-authors determined.
The researchers also noted that expanded screening and treatment alone would not be sufficient to reduce HCV among individuals most at risk — injection-drug users.
“In order to completely eliminate HCV, efforts to access that community are extremely important,” said Dr. David Durham, lead author of the study and an associate research scientist. Such efforts might include enhanced screening and treatment with the new therapies in combination with targeted behavioral interventions such as needle-exchange programs or opioid substitution therapy.
Approximately 2.7 million people in the United States have chronic HCV Infection to the Centers for Disease Control and Prevention. Worldwide, an estimated 170 million people are living with the virus, which is primarily transmitted through exposure to infectious blood.
“We should be very optimistic about the prospect of eliminating HCV as a disease within the United States using these direct acting antivirals, especially if they are combined with targeted behavioral interventions to reduce transmission,” said Dr. Townsend. However, he added, “due to the currently high cost of these treatments, as a society we need to think carefully about how to make that happen.”
Other Yale authors include Ms. Laura A. Skrip, Dr. R. Douglas Bruce, Dr. Silvia Vilarinho, Ms. Alison P. Galvani, and Ms. Elamin H. Elbasha. The Notsew Orm Sands Foundation and Merck funded the research.