Elimination of hepatitis C in Europe: can WHO targets be achieved?

Abstract

Background: Chronic hepatitis C virus (HCV) infection affects 71 million people worldwide. The availability of highly efficient direct-acting antivirals has revolutionized the treatment landscape with over 95% cure rates. The WHO has launched a global programme to achieve rather ambitious HCV elimination targets for 2030. Objectives: This article aims to provide a critical overview of the current HCV elimination programmes in Europe highlighting the elements that should be implemented to achieve elimination and those that are already in place to promote this process. Sources: Review of the recently published literature and opinion of experts in the field. Content: Elimination of hepatitis C as a public health threat appears to be a difficult task, which should be subdivided into smaller targets, the so-called micro-elimination goals, to increase chances of success. Macro-elimination strategies based on mass-screening are difficult to implement. Evidence supporting the efficacy of micro-elimination comes from key populations, such as people who inject drugs. HCV elimination is proceeding at different speeds in Europe. Some countries are on target with the WHO's objectives whereas others lack economic support and political advocacy, and have insufficient infrastructures to achieve this. The absence of an effective prophylactic vaccine is hampering the process and should be overcome. Implications: Elimination of hepatitis C worldwide appears plausible, but in several countries probably not within the time frame suggested by the WHO. In the absence of vaccination, universal access to HCV treatment would act as a 'therapeutic' option to reduce transmission, especially in high-risk populations.

Development of a downstream process for the production of an inactivated whole hepatitis C virus vaccine

“…Furthermore, resistance to DAA is increasing and might compromise future treatment efficacy 10 , 11 . Thus, a vaccine is urgently needed to control HCV on a global scale 12 – 14 .…”

Comparison of double antigen sandwich and indirect enzyme‐linked immunosorbent assay for the diagnosis of hepatitis C virus antibodies

“…However, there is not any effective vaccine to prevent HCV infection. 21 The successful development and clinical application of HCV vaccine are unpredictable. 22 In sum- Meanwhile, detection of HCV-Ag has the advantages of relatively low cost, handiness, and simplicity and not need to add special instruments.…”

Progress and Barriers Towards Elimination of Chronic Hepatitis C in Children

“…Average prevalence of 1.8-5.8 % is reported in developing countries, and the lowest of 0.05-0.36 % in the United States and Europe [1,4,15,23,31,32,49]. Mother-to-child transmission (MTCT) accounts for most HCV infections in pediatric patients [2,8,12,17,24,26,27,37,40,50,54]. Injection drug use, high-risk sexual practices, especially among men who have sex with men, and through tattooing in unregulated settings is the main mode of transmission among young adults and teenagers.…”