Hepatitis C Elimination is the Gateway to Holistic Liver Health

As we mark three years of the COVID-19 pandemic, we note that the momentum to eliminate hepatitis C has significantly decelerated. Here at the 48^th Annual Congress of the Spanish Association for the Study of the Liver (Asociación Española para el Estudio del Hígado [AEEH]), we would like to make a call to action to take back the reins of this challenge and pick up the fight against HCV, in line with the World Health Organization’s (WHO) 2016 plan for elimination by 2030.

Currently, only eleven high-income countries are on track to meet WHO’s goal by 2030. In 2020, consultations and referrals for HCV infections in Europe dramatically decreased in comparison to 2019, resulting in a 41% and 49% decline, respectively. Consequently, the number of patients that initiated HCV treatment dropped by more than half, to 52%. This downtrend can lead to severe consequences for people living with HCV, health systems, and ultimately, equity in healthcare access.

The impact of a late hepatitis C diagnosis

Patients that receive a late HCV diagnosis are at higher risk of developing severe hepatic consequences, such as advanced cirrhosis, hepatocellular carcinoma, or the need for a liver transplant, as well as extrahepatic manifestations, like cardiovascular disease or diabetes, which are all potentially deadly.

Furthermore, health systems suffer from a substantial care provision and financial burden as a consequence of the costly management of conditions derived from HCV. The good news is that direct acting antivirals (DAAs) can not only cure >95% of HCV-positive patients but also allow for major decreases in HCV-related costs for health systems, despite their cost, reiterating the importance of early diagnosis and treatment initiation.

Hepatitis C in Spain

Although the fact that Spain is in line with WHO’s HCV treatment target, diagnostic rates, which were already low pre-pandemic, have been further hindered as a result of COVID-19. Moreover, the number of late diagnoses is seriously high, highlighting the need to develop new screening strategies to access marginalised populations, who have some of the highest rates of HCV. Micro-elimination strategies, such as those that we are implementing in the Balearic Islands and Catalonia, and in collaboration with counterparts in Madrid, Milan, and Athens, can serve as models of care to reach those that are hardest to reach.

In order to get back on track in the battle against HCV, it is critical to implement interventions that allow for early diagnosis of HCV, through simplified, rapid, and comprehensive diagnostic methods. These interventions must be accompanied by decentralised healthcare management, to reach populations at higher risk of infection, such as people who inject drugs, and those who are less likely to interact with the health system, like migrants. Having a national strategy, not only for HCV but for all liver diseases, is also pivotal. Each of these pieces will contribute to the development of an optimised system for the management of positive HCV cases and get us closer to the goal of eliminating this disease within the decade.