Kris Kowdley, MD: The Opioid Epidemic is Burdening Hepatitis C Elimination

The World Health Organization (WHO) and National Academy of Science (NAS) set a goal to eliminate hepatitis C virus (HCV) by 2030, on the basis of breakthroughs in highly efficacious direct-acting antiviral (DAA) treatment and structured framework for preventive strategies.¹

Though one expert views the global goal as a “laudable target,” he has reasonable doubt on the US’ ability to achieve HCV elimination due to a concurrent health epidemic.

In an interview with HCPLive, Kris V. Kowdley, MD, director of the Liver Institute Northwest and professor of medicine at Elson S. Floyd College of Medicine at Washington State University, discussed the interplay of HCV prevalence and burden and the ongoing opioid crisis.

“Unfortunately, the goal is slipping away from us because of the opioid epidemic and the associated tragedy of hepatitis C, where it’s now clear that about one-third of patients who are using injection drugs are getting hepatitis C,” he said.

The 2030 elimination goal is currently moving further away from clinicians, and Kowdley recommends clinical efforts be doubled. In one such case, he advocated for his colleagues to consider treatment as a preventive strategy, particularly in the population who inject drugs.

“I think we have to recognize that if we don’t treat that population, we’re not going to eliminate hepatitis C,” Kowdley said. “And that needs to come along with awareness, funding and support. You only cure the people you treat.”

Kowdley also advocated for the use of new modeling systems that would take greater consideration to out-of-reach patients—those without access to a health care professional or those who may need supplemental support for mental health or addiction treatment.

“Along those same lines, we need to continue our efforts to develop a vaccine, and we need to continue our efforts to develop long-acting treatments,” he added. “We need to be more creative in how we identify patients, and we need to be more creative in how we merge treatment at point-of-care where these patients may be seeking care.”

Though there has been significant slow-down in vaccine research and development due to the significant effectiveness and wide availability of DAAs, scientists are also encountering complex hurdles in advancing prophylactic options.

“I think we’ve got to get a better handle on virology to be able to develop effective vaccines,” Kowdley explained. “It’s a very unstable virus and it mutates very rapidly. If you don’t create a vaccine that can cover a very broad range of genotypes and can anticipate the potential sequence variance we develop, it’s going to be a challenge.”

He added that the field needs to consider the ramifications and opportunities of combining hepatitis C and addiction or pain treatment strategies in patients with comorbid opioid addictions. Additionally, chronic diseases like diabetes are becoming more prevalent in the population.

“We need to combine this with education about nutrition, exercise, healthy living, and that is not going to be possible if we don’t recognize that certain patients live in food desserts, don’t have access to healthy foods or can’t afford them,” Kowdely said. “So we have to treat the patient in a holistic manner.”

References

1. ^{World Health Organization. WHO releases first-ever global guidance for country validation of viral hepatitis B and C elimination. Press release. Published June 25, 2021. https://www.who.int/news/item/25-06-2021-who-releases-first-ever-global-guidance-for-country-validation-of-viral-hepatitis-b-and-c-elimination}