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Journal of Gastronenterology and Digestive Diseases
|
Volume 3
J u n e 2 5 - 2 6 , 2 0 1 8 | D u b l i n , I r e l a n d
GASTROENTEROLOGY
International Conference on
HEPATITIS C ERADICATION: A PROMISE UNFULFILLED
David H Van Thiel
Rush University Medical Centre, USA
H
epatitis non-A and non-B hepatitis was recognized as a unique form of viral hepatitis distinct from hepatitis A, hepatitis B, and
other unusual types of a chronic hepatitis such as CMV, EBV as well other more uncommon types of viral hepatitis in the late
1970s. His clinical characteristics, biochemical manifestations as well as its chronicity from its initial presentation followed by
increasing stages of chronic hepatitis and hepatic fibrosis ultimately resulting in cirrhosis and occasionally progressing to hepatic
cancer and required an additional 15-30 years. A host of potentially antiviral agents were utilized initially to treat the disease
process with minimal or no success. With the introduction of interferons (alfa 2a or alfa 2b) with or without additional ribavirin,
a modicum of success defined as a reduction in transaminase levels was achieved with little or no retrospectively determined
viral clearance. With the isolation and characterization of the hepatitis C virus genome and the various polypeptides it codes
for, a new era of treatment directed at inhibiting viral replication as opposed to enhancing the immune response against the
virus began. The initial direct acting antiviral agents increased viral clearance rates to 40%. Agents more recently developed have
increased the rates of viral clearance to 95 to 100%. This initiated reports (a promise) that hepatitis C would be eliminated as a
disease process by 2020 with a progressive decline in the rates of cirrhosis and hepatocellular carcinoma thereafter through at
least 2030. Unfortunately, this does not appear to be the case as multiple obstacles prevent these favourable outcomes. The
issues and remaining and prohibit the promises full film and include the following: Lack of knowledge of primary care physician’s
that the disease is a serious hepatic disease that slowly and quietly progresses to cirrhosis and potentially hepatic cancer and
is treatable. As a result, large numbers estimated to be three quarters of the infected population failed to be identified. Secondly
the cost of the drugs is prohibitive to those individuals with no insurance and contributes to the effort by third party pears and
cover mental agencies to limit treatment to selected groups with advanced liver disease. As a result, only, a minor fraction of the
infected population is identified for treatment and receives treatment. In addition, individuals with non-hepatic manifestations
of hepatitis C are not recognized this having the disease process and are excluded from treatment even though this population
represents the largest group of individuals perpetuating the disease in the community as they do not know they have the disease.
In order with a promise of the elimination of hepatitis C and a reduction in long-term consequences of the infection universal
defecation of infected patients to include all forms of hepatic dysfunction as well as nonhaptic manifestations of the disease need
to be recognized in treated. To accomplish this the cost of treatment will have to be dramatically reduced and includes not only
the cost of the therapeutic agent but also through numerous tests required to justify treatment. Some progress is being made by
governmental agencies that are looking at the concept of micro-elimination as a potential means of reducing the prevalence of the
disease in high prevalence groups such as men having sex with men, individuals enrolled in drug treatment programs, who said
receive multiple transfusions as result of clotting disorders and/or haemolytic anaemias. This is clearly a started but only if start.
dvanthiel@dr.comJ Gastroenterol Dig Dis 2018, Volume 3