World Health Organization calls for ambitious global targets for viral hepatitis control

The World Health Organization (WHO) is calling for ambitious new global targets for diagnosis, treatment and cure of viral hepatitis, signalling a major increase in momentum towards elimination of viral hepatitis by 2030.

Dr Gottfried Hirnschall, director of the Department of HIV/AIDS and Hepatitis of WHO told the World Hepatitis Summit in Glasgow on Wednesday that WHO will seek international agreement for the following targets:

  • 90% reduction in new cases of chronic hepatitis B and C
  • 65% reduction in hepatitis B and C deaths
  • 80% of treatment eligible persons with chronic hepatitis B and C infections treated

Global mortality due to viral hepatitis is now outstripping deaths from HIV, tuberculosis or malaria, Dr Hirnschall said, and whereas deaths as a result of HIV and malaria have been declining for several years due to improvements in prevention and treatment coverage, mortality due to hepatitis A, B and C is still rising. Approximately 80% of all deaths from liver cancer are a consequence of viral hepatitis.

Glossary

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

malaria

A serious disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. 

middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are around 50 lower-middle income countries (mostly in Africa and Asia) and around 60 upper-middle income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

hepatitis A virus (HAV)

The hepatitis A virus is transmitted through contaminated food and water, as well as human faeces. It can be passed on during sex, particularly rimming (oral-anal contact). Symptoms usually last less than two months, although they continue in some people for up to six months. Drug treatment is not needed. A vaccine is available to prevent hepatitis A.

 

cirrhosis

Severe fibrosis, or scarring of organs. The structure of the organs is altered, and their function diminished. The term cirrhosis is often used in relation to the liver. 

The World Health Organization estimates that approximately 400 million people worldwide are living with hepatitis B or C, but awareness of viral hepatitis as a major public health challenge remains limited. The World Hepatitis Summit, taking place in Glasgow, Scotland, this week, was convened by WHO and the World Hepatitis Alliance – the international federation of civil society groups representing people with hepatitis. The summit is designed to raise awareness among policy makers of the need for what the organisers describe as comprehensive national plans encompassing prevention, diagnosis and treatment of viral hepatitis.

Dr Hirnschall praised several lower-income and middle-income countries for recent expansions in viral hepatitis programmes.

Georgia, one of several states in Eastern Europe with a high prevalence of hepatitis C attributable to injecting drug use, has embarked on an ambitious programme designed to eliminate hepatitis C, in partnership with the US Centers for Disease Control and Prevention (CDC) and Gilead Sciences, the manufacturer of sofosbuvir (Sovaldi). Georgia’s programme is intended, in part, to demonstrate that elimination – the ending of transmission resulting in the disappearance of disease over several decades – is a feasible proposition even for middle-income countries with limited health systems. By negotiating a substantial price reduction in the cost of treatment from Gilead Sciences, and with advice and training on programme design and monitoring, Georgia aims to treat 5000 people with advanced liver damage and to screen 70,000 people for hepatitis C in 2015 alone, with an increase in volume in subsequent years, Dr David Sergeenko, Georgian Minister of Labour, Health and Social Affairs told the summit.

Egypt, the country with the highest prevalence of hepatitis C in the world, has treated 100,000 people in the past year as a result of negotiated price reductions in the costs of sofosbuvir and pegylated interferon. Two hundred thousand people registered online for evaluation for free treatment within three days of the launch of a government website earlier this year, and 1.1 million had registered by July 2015, but Egypt will only treat those with the most advanced liver disease – 350,000 people over the next three years. Despite the advanced disease stage of people treated so far, cure rates are very high: approximately 85% of those with cirrhosis have been cured, said Professor Imam Waked of the National Liver Institute, Cairo.

Although ‘champion’ countries are leading the way in the use of new medications which can cure hepatitis C, funding remains limited at both national and international levels. WHO is proposing an interim target of 8 million people treated for viral hepatitis by 2020 – 5 million treated for hepatitis B and 3 million for hepatitis C – but without reductions in drug prices these targets are unlikely to be achieved.

But, “action will be cheaper than inaction” said Dr Hirnschall, emphasising the accumulating costs of untreated viral hepatitis in the forms of liver cancer and hospitalisation. A 90% reduction in new cases of chronic hepatitis B and C by 2030, for example, would reduce the burden of new infections from 6-10 million in 2015 to 900,000 per year by 2030. Achievement of the diagnosis and treatment targets would result in a 65% reduction in deaths by 2030, from 1.4 million in 2015 to 500,000 deaths in 2030.

How to mobilise the necessary funding – and how to reduce the cost of treatment – will be the subjects of further discussion during the summit and will be covered in future reports on aidsmap.com. Reducing drug costs will be critical, but reducing the cost of delivering care through simplified treatment packages and sharing of infrastructure and services with other programmes such as HIV, immunisation and blood safety programmes will also be needed to make elimination affordable.

For more information on the World Hepatitis Summit visit www.worldhepatitissummit.com