Monday, August 4, 2014

U.S. hepatitis C burden may ease in coming decades: study

U.S. hepatitis C burden may ease in coming decades: study

Mon Aug 4, 2014 5:15pm EDT

(Reuters Health) - Hepatitis C may become a “rare” disease in the U.S. in about 20 years, according to a new computer model.

About one in 100 people are currently infected with the hepatitis C virus in the U.S. but that may drop to about one in 1,500 people by 2036 thanks to new medicines and increased screening regimens, researchers suggest.

“We were pleasantly surprised that in the next 22 years we could make this a rare disease,” said Jagpreet Chhatwal, the study’s senior author from The University of Texas MD Anderson Cancer Center in Houston.

Hepatitis C is a viral infection of the liver that is typically transmitted when the blood of an infected person enters the body of a healthy person. Its symptoms include fever, nausea, stomach and joint pain, dark urine, vomiting and a yellowing of the skin and eyes.

If left untreated, hepatitis C can lead to liver damage, liver failure and cancer, according to the Centers for Disease Control and Prevention (CDC). It may also lead to death.

The researchers write in the Annals of Internal Medicine that about 3.2 million people in the U.S. have chronic hepatitis C infections that cost the country about $6.5 billion per year.

Treatment of hepatitis C infections recently changed with the availability of new antiviral medicines in 2011 and the more recent release of pill from Gilead Sciences known as Sovaldi to treat the virus.

And the CDC and the government-backed U.S. Preventive Services Task Force recently endorsed expanded hepatitis C screenings for every adult born between 1945 and 1965.

“We were curious how the trend will change,” Chhatwal said. “How will it dip or drop?”

For the study, he and his colleagues used a computer model to estimate how the benefits of the new medicines and expanded screenings might change the burden of hepatitis C infection in the U.S. during the coming decades.

Under current conditions, hepatitis C would become a “rare” disease, defined as a condition affecting no more than one in 1,500 people, by 2036. The U.S. could reach that goal by 2026 by adopting a more aggressive screening protocol, they add.

The researchers write that the current screening regimen would identify about 487,000 cases of hepatitis C infection within the next 10 years. That could increase to 933,700 cases if a one-time, universal screening policy is adopted.

Chhatwal said additional research is needed about the effects of expanded screening for hepatitis C infections.

Still, under current conditions, he and his team found that 124,200 cases of severe liver cirrhosis, 78,800 cases of liver cancer, 126,500 liver-related deaths and 9,900 liver transplants may be prevented by 2050.

“We are moving in a positive direction,” Chhatwal said. “These updates and advances we expect will help patients and the healthcare system as well.”

He cautions that it will only be possible if people have timely and affordable treatment for hepatitis C infections.

SOURCE: Annals of Internal Medicine, online August 4, 2014.

Changing burden of Hepatitis C virus infection in the United States
The latest issue of the Annals of Internal Medicine makes predictions on the changing burden of Hepatitis C virus infection.Chronic hepatitis C virus (HCV) infection causes a substantial health and economic burden in the United States. With the availability of direct-acting antiviral agents, recently approved therapies and those under development, and 1-time birth-cohort screening, the burden of this disease is expected to decrease.

Dr Chhatwal and colleagues from Texas, USA predicted the effect of new therapies and screening on chronic HCV infection and associated disease outcomes.

The research team evaluated existing and anticipated therapies and screening for HCV infection in the United States.

The team assessed the total HCV-infected population in the United States.

Outcomes included the number of cases of chronic HCV infection and outcomes of advanced-stage HCV infection.

The number of cases of chronic HCV infection decreased from 3.2 million in 2001 to 2.3 million in 2013.

The researchers report that 1-time birth-cohort screening beginning in 2013 is expected to identify 487,000 cases of HCV infection in the next 10 years.

In contrast, 1-time universal screening could identify 933,700 cases.
With the availability of highly effective therapies, HCV infection could become a rare disease in the next 22 years.

The team found that recently approved therapies for HCV infection and 1-time birth-cohort screening could prevent approximately 124,200 cases of decompensated cirrhosis, 78,800 cases of hepatocellular carcinoma, 126,500 liver-related deaths, and 9900 liver transplantations by 2050.
Increasing the treatment capacity would further reduce the burden of HCV disease.

Dr Chhatwal's team concludes, "New therapies for HCV infection and widespread implementation of screening and treatment will play an important role in reducing the burden of HCV disease."
"More aggressive screening recommendations are needed to identify a large pool of infected patients."
Ann Intern Med 2014; 161(3): 170-180
06 August 2014

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