Is global (or regional) HCV elimination a realistic objective?

Alfredo Alberti – Department of Molecular Medicine University of Padova, Italia


ABSTRACT

A number of direct antiviral agents against the hepatitis C virus have recently become
available and proven highly effective in terminating chronic infection in the vast majority
of treated patients. Considering that HCV carriers represent the exclusive reservoir of
hepatitis C in nature, there is the possibility to use antiviral therapy to achieve elimination
of Hepatitis C . In an outcome model developed by the World Health Organization, global
HCV elimination can be obtained by identifying 90% of infected individuals, and by treating
at least 80% , and this is expected to generate drastic reduction in hepatitis C incidence
and prevalence, with >65% reduction in HCV related morbidities and mortality. To achieve
such ambitious goal, WHO has called into action individual State Members to organize
National HCV elimination programs. These programs should be further decentralized into
microelimination programs adjusted to the local epidemiology and resources. HCV elimination
actions need to combine increased awareness on the infection and disease in the
Community, clinical case finding and targeted screening intervention, effective linkage to
care and educational programs on prevention of transmission and reinfection for high
risk groups. Unrestricted access to antiviral therapy and adequate financial support and
infrastructures for large scale treatment programs are obviously essential prerequisites
to start any HCV elimination programs. However they are necessary but not sufficient, as
the main barriers to achieve the final goal currently consist in the asymptomatic nature of
chronic HCV infection, with large numbers of yet undiagnosed cases requiring extensive
and expensive screening programs, and in the substantial risk of reinfection in patients
with risk behaviors, in the absence of a prophylactic vaccine and of strict adherence to
harm reduction strategies. With these caveats in mind, HCV elimination programs are
currently planned in many Countries, including Italy.
Parole chiave: Hepatitis C; Global Elimination; Direct Antiviral Agents


Articolo presente in – Cure and Chronicity N.1 


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