Originally published by our sister publication Gastroenterology & Endoscopy News
By Ethan Covey
Only 34% of people with diagnosed hepatitis C virus (HCV) in the United States have achieved viral clearance, according to data from 2013 to 2022.
This finding means progress is lagging far behind goals set by the Viral Hepatitis National Strategic Plan for the nation, which calls for at least 80% of people with HCV to achieve viral clearance by 2030 (MMWR Morb Mortal Wkly Rep 2023;72:716-720).
“The findings are incredibly concerning,” Carolyn Wester, MD, the director of the Division of Viral Hepatitis in the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in an interview.
“There are over 2 million people living with hepatitis C in the U.S.,” Dr. Wester said. “It’s a silent killer. ...most people don’t know they have symptoms until they have advanced disease. Fortunately, breakthrough cures have become available over the last decade.”
The report analyzed data from a large commercial laboratory, focused on a total of 1,719,493 people who were identified as having HCV from Jan. 1, 2013 through Dec. 31, 2021—the decade since highly effective direct-acting antiviral hepatitis C treatments became available. Data came from all 50 states and the District of Columbia.
During the decade, 88% of infected people were classified as having received viral testing. Among those who received viral testing, 69% were classified as having initial infection. Of that group, 34% were classified as cured or cleared; and of those patients, 7% were categorized as having persistent infection or reinfection.
“After a decade of having a breakthrough cure, only one out of three people diagnosed with hepatitis C has actually been cured,” Dr. Wester said, noting that this is “just part of the story.”
“We know that upstream of that, an estimated 40% of people with hepatitis C aren’t even diagnosed,” she added.
Viral clearance was lowest in people 20 to 39 years of age (24%), and individuals 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).
Factors Preventing Treatment
“We know that there are a lot of factors inhibiting the ability of people with hepatitis C to get linked to curative treatment, but even among those who are diagnosed, some of the factors include the high cost of treatment, insurance restrictions, and the fact that treatment isn’t available in many of the settings where people with hepatitis C receive care,” Dr. Wester said.
Primary care settings may not offer HCV treatment services, she said. In addition, many individuals are not receiving care via longitudinal primary care settings and instead access services at syringe service programs, substance abuse disorder treatment clinics, correctional facilities or emergency departments. “Those settings might be set up to diagnose but not to treat,” Dr. Wester said.
Furthermore, while the high cost of care has come down, it is still cost-prohibitive for many people, with or without insurance.
Barriers Need to Be Addressed
Dr. Wester stressed that the results of the study highlight that action must be taken promptly to address the multiple barriers that are preventing people with HCV from receiving services and achieving viral clearance.
“Even the groups that did the best—individuals 60 and older with commercial or Medicare insurance—still only had evidence of viral clearance at 48%,” she said.
“There is a big opportunity, but a big problem as well,” Dr. Wester added. “Right now, we need a big solution. The Biden-Harris administration has proposed a national hepatitis C elimination program, which would provide for rapid diagnosis, affordable treatment, and access to testing and cure in a variety of settings where people receive care. We can’t wait another 10 years. Everyone with hepatitis C deserves to be cured.”