Can Hepatitis B and HCV Be Eliminated?

A report from the National Academy of Sciences (NAS) suggests that the elimination of hepatitis B and C as a public health problem is possible, but that time and considerable resources will need to be devoted to stopping the transmission of the disease and treating all those who are infected.

The report itself is a treasure trove of a document on the current and potentially rosy future state of hepatitis globally. The present, though, is still surprisingly sober given the recent stunning advances in treatment, particularly for the hepatitis C virus (HCV). As the report notes, in 2013, viral hepatitis (which includes both HCV and hepatitis B), surpassed HIV and AIDS to become the seventh leading cause of death worldwide. Together, the diseases lead to the deaths of approximately 20,000 people every year in the US alone.

While the report does not suggest that complete elimination of the diseases is possible, it draws the distinction that ending their transmission in the US, and for the infections that remain, preventing their undesirable signs and symptoms entirely, is feasible given therapeutic advances and clinical knowledge about disease transmission.

The first step in eliminating hepatitis B, according to the report, is universal immunization for it. The vaccine for hepatitis B, which is administered in 3 doses, offers long-lasting 95% immunity. Improvements in medical practices around pregnant mothers transferring the disease to children could prevent mother-to-child transmission, and improvements in vaccination rates—particularly people at elevated risk of contracting hepatitis B—would be part of the larger prevention effort. Current hepatitis B treatment does not amount to a cure, but treatment prevents disease progression and deaths from cirrhosis and liver cancer.

Hepatitis C efforts might center on needle exchange programs and drug treatment advances, given that many cases of HCV are transmitted through contact with infected blood. Hepatitis C can be cured in eight to 12 weeks with new, direct-acting antiviral drugs -- which can elicit sustained response in 94 percent to 99 percent of patients. Given the number of available drugs and the number of promising agents in the pipeline, odds of finding an effective cure for any given patient are extraordinarily high. But the high costs of the medications are a major obstacle to more widespread treatment.

The report discusses in some depth other obstacles to treatment and prevention, including difficulties diagnosing both conditions, insufficient local and national surveillance efforts, potential stigma of the diseases preventing those infected from seeking treatment, and the fact that both forms of the disease are asymptomatic for some period.