New Treatments Could Dramatically Reduce Hepatitis C Burden


Widespread screening and use of new direct-acting antivirals could make hepatitis C a rare disease within the next 2 decades, according to results from a mathematical modeling study published in the August 5 edition of Annals of Internal Medicine. Universal screening and treatment could prevent more than 161,000 liver-related deaths, they projected.

Estimates indicate that approximately 3 million people in the U.S., and as many as 150 million worldwide, are living with hepatitis C virus (HCV) infection. Over years or decades chronic infection can cause serious liver disease including cirrhosis and liver cancer, and -- along with hepatitis B -- it is the leading reason for liver transplants.

The advent of direct-acting antiviral agents that target different steps of the HCV lifecycle have brought about a revolution in hepatitis C treatment, especially with the pending availability of interferon-free regimens for HCV genotype 1, the most common type and the hardest to treat. Studies show that the new drugs can cure upwards of 90% of people with hepatitis C, and experts have begun to discuss the potential for HCV treatment-as-prevention.

Mina Kabiri from the University of Pittsburgh, Jagpreet Chhatwal from the University of Texas MD Anderson Cancer Center, and colleagues used an individual-level state-transition mathematical model to predict the effect of expanded screening and new therapies on the burden of chronic HCV infection and associated disease outcomes over time.

The U.S Centers for Disease Control and Prevention (CDC) and Preventive Services Task Force recommend that all U.S. adults born between 1945 and 1965 should be screened for HCV at least once as part of their routine health care, as Baby Boomers have by far the highest prevalence of chronic hepatitis C.

The researchers suggested that the number of cases of chronic HCV infection has already decreased from 3.2 million in 2001 to 2.3 million in 2013. (Other recent estimates range from 2.7 million to a minimum 5.2 million.)

One-time birth-cohort screening for Baby Boomers starting in 2013 would be expected to identify 487,000 new cases of HCV infection over the next 10 years, while one-time universal screening could identify 933,700 new cases, they projected.

They further estimated that birth-cohort screening plus treatment using recently approved HCV therapies could prevent approximately 124,200 cases of decompensated cirrhosis or liver failure, 78,800 cases of hepatocellular carcinoma, 126,500 liver-related deaths, and 9900 liver transplants by 2050. Universal screening would raise all these estimates."

With the availability of highly effective therapies, HCV infection could become a rare disease in the next 22 years," the study authors concluded. "New therapies for HCV infection and widespread implementation of screening and treatment will play an important role in reducing the burden of HCV disease."

Below is an edited excerpt from an MD Anderson Cancer Center news release describing the study findings in more detail.

Study Predicts Hepatitis C Will Become a Rare Disease in 22 Years

Computer simulation forecasts favorable trends in eradicating hepatitis C

August 8, 2014 -- Effective new drugs and screening would make hepatitis C a rare disease by 2036, according to a computer simulation conducted by The University of Texas MD Anderson Cancer Center and the University of Pittsburgh Graduate School of Public Health. The results of the simulation are reported in the August 5 edition of the journal Annals of Internal Medicine.

"Hepatitis C (HCV) is the leading cause of liver cancer and accounts for more than 15,000 deaths in the U.S. each year," said Jagpreet Chhatwal, PhD, assistant professor of Health Services Research at MD Anderson, and corresponding author on the study. 

"If we can improve access to treatment and incorporate more aggressive screening guidelines, we can reduce the number of chronic HCV cases, prevent more cases of liver cancer and reduce liver-related deaths," Chhatwal said.

HCV -- a virus transmitted through the blood -- is spread by sharing of needles, the use of contaminated medical equipment, and by tattoo and piercing equipment that has not been fully sterilized. Those at the highest risk for exposure are baby boomers -- people born between 1945 and 1965. Widespread screening of the U.S. blood supply for hepatitis C began in 1992. A majority of people were infected through blood transfusions or organ transplants before 1992.

Baby boomers account for 75 percent of the estimated 2.7 to 3.9 million people infected in the United States. Half of people with the virus are not aware they are infected. The Centers for Disease Control and Prevention, and the U.S. Preventive Services Task Force now recommend a one-time HCV screening for this population group.

In this study, Chhatwal and his collaborators used a mathematical model with information from several sources including more than 30 clinical trials to predict the impact of new therapies called "direct-acting antivirals" and the use of screening for chronic HCV cases.

Researchers developed a computer model to analyze and predict disease trends from 2001 to 2050. The model was validated with historical data including a recently published national survey on HCV prevalence. Researchers predicted with new screening guidelines and therapies, HCV will only affect one in 1,500 people in the U.S. by 2036.

The model predicts one-time HCV screening of baby boomers would help identify 487,000 cases over the next 10 years.

"Though impactful, the new screening guideline does not identity the large number of HCV patients who would progress to advanced disease stages without treatment and could die," Chhatwal said.

"Making hepatitis C a rare disease would be a tremendous, life-saving accomplishment," said lead author Mina Kabiri, a doctoral student at the University of Pittsburgh Graduate School of Public Health. "However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening."

In this study, researchers predicted a one-time universal screening could identify 933,700 HCV cases. Chhatwal and his colleagues also predict the universal screening and timely treatment can make HCV a rare disease in the next 12 years. Such screening can further prevent:

Chhatwal, whose current research focuses on evaluations of cancer prevention strategies using quantitative methods, says the availability of highly effective therapies and screening updates provide a great opportunity to tackle the hepatitis C epidemic. "But we need to ensure that we provide timely and affordable access to treatment to achieve the potential benefits."

"The new treatment that costs $1,000 a day has been a subject of debate and can become a barrier to timely access to all patients," Chhatwal said.

"Although recent screening recommendations are helpful in decreasing the chronic HCV infection rates, more aggressive screening recommendations and ongoing therapeutic advances are essential to reducing the burden, preventing liver-related deaths and eventually eradicating HCV," Chhatwal said.

The National Institutes of Health (KL2TR000146) funded this research.

Other researchers contributing to this study include Mark Roberts, MD of the University of Pittsburgh Graduate School of Public Health; Alison Jazwinski, MD of the University of Pittsburgh Medical Center, and Andrew Schaefer, PhD of University of Pittsburgh Swanson School of Engineering.



M Kabiri, AB Jazwinski, MS Roberts, J Chhatwal, et al. The Changing Burden of Hepatitis C Virus Infection in the United States: Model-Based Predictions. Annals of Internal Medicine 161(3):170-180. August 5, 2014.

Other Source

University of Texas MD Anderson Cancer Center. Study Predicts Hepatitis C Will Become a Rare Disease in 22 Years. Press release. August 4, 2014.