Screening and drug therapy predicted to make hepatitis C a rare disease

August 4, 2014, University of Pittsburgh Schools of the Health Sciences
Electron micrographs of hepatitis C virus purified from cell culture. Scale bar is 50 nanometers. Credit: Center for the Study of Hepatitis C, The Rockefeller University.

Newly implemented screening guidelines and improved, highly effective drug therapies could make hepatitis C a rare disease in the United States by 2036, according to the results of a predictive model developed at the University of Pittsburgh Graduate School of Public Health.

The results of the analysis, funded by the National Institutes of Health (NIH) and performed with the University of Texas MD Anderson Cancer Center, are published in the Aug. 5 issue of the Annals of Internal Medicine.

A "rare" disease is one that affects at most one in every 1,500 people. Approximately one in every 100 people in the U.S. currently has chronic C, a viral infection that compromises liver function.

"Making hepatitis C a would be a tremendous, life-saving accomplishment," said lead author Mina Kabiri, M.S., a doctoral student in Pitt Public Health's Department of Health Policy and Management. "However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening."

In the U.S., hepatitis C is the leading cause of chronic liver disease and the leading reason for liver transplantation. At 15,100 deaths annually, hepatitis C surpassed the annual number of deaths from HIV in 2007. The economic burden associated with chronic infection is estimated at $6.5 billion a year.

"This is, indeed, a very interesting time for hepatitis C patients and providers," said senior author Jagpreet Chhatwal, Ph.D., now of the University of Texas MD Anderson Cancer Center, who performed most of the research while at Pitt Public Health. "Several changes have happened in the last two years, including screening policy updates and availability of highly effective therapies."

In 2012, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommended that anyone born between 1945 and 1965—encompassing about 81 percent of chronically infected people—receive a one-time screening for hepatitis C. Hepatitis C often is asymptomatic, meaning that infected people do not know they have it until it is detected through a blood screening.

In early 2014, hepatitis C drug regimens that could be taken orally were introduced to the market, allowing and infectious disease specialists to take on the role of treating hepatitis C patients. The drugs have been shown to be highly effective in making the virus almost undetectable in the blood of patients previously found positive for hepatitis C.

The research team created a highly detailed computer model of the natural history and progression of hepatitis C, both with and without treatment. The model predicts the number of hepatitis C infections in the U.S. at any given time from 2001 to 2050, under multiple potential scenarios describing future treatment, while taking into consideration infection status awareness, stage of disease, treatment history and continued drug development, based on data from the National Health and Nutrition Examination Survey (NHANES) and published clinical studies.

To validate the prediction, the researchers ran the model for the years 2003 to 2010 and predicted 2.7 million cases of hepatitis C, which equaled the actual number of cases reported by NHANES.

The research team then considered what would happen if the guidelines were increased to include a one-time universal screening for hepatitis C among all U.S. citizens, not just baby boomers.

"In that scenario, nearly 1 million cases of hepatitis C would be identified in the next 10 years," said Ms. Kabiri. "And that translates into making hepatitis C a rare disease by 2026, a decade earlier than we'd predicted with the current screening guidelines."

The researchers note that such a measure would bring increased costs. The oral therapy regimen costs as much as $1,000 per day.

The model estimated that universal screening coupled with the new drug therapies would reduce liver-related deaths by 161,500 and liver transplants by 13,900 from 2014 to 2050.

"Though impactful, the new screening guidelines do not identity the large number of hepatitis C patients who would progress to advanced disease stages without treatment and could die," said Dr. Chhatwal. "More aggressive screening recommendations are essential in further reducing the burden, preventing liver-related deaths and eventually eradicating hepatitis C."

Future research will be needed to determine how the reduction in deaths and transplants offsets the increased costs of screening and drug therapy.

Explore further: Experts call for stepped-up hepatitis battle

Related Stories

Experts call for stepped-up hepatitis battle

July 24, 2014
The world can beat the cancer-causing disease hepatitis if it raises its game, but treatment programmes need to go hand in hand with those tackling the likes of HIV, experts said Thursday.

Major gaps in hepatitis C care identified as new drugs and screening efforts emerge

July 2, 2014
A new meta-analysis published online in PLOS ONE by infectious disease and epidemiology specialists from the Perelman School of Medicine at the University of Pennsylvania highlights significant gaps in hepatitis C care that ...

Deaths from viral hepatitis surpasses HIV/AIDS as preventable cause of deaths in Australia

April 17, 2014
The analysis was conducted by Dr Benjamin Cowie and Ms Jennifer MacLachlan from the University of Melbourne and Melbourne Health, and was presented at The International Liver Congress in London earlier this month.

Pancreatic, liver disease shift up on risk list

May 23, 2014
Money changes everything. To date, lung, breast, prostate and colorectal cancers have accounted for the largest number of cancer deaths. In response, these cancers currently receive the most research funding from the National ...

Hepatitis B screening proposed for all high-risk adults

February 11, 2014
(HealthDay)—Adults at high risk for hepatitis B should be screened for the viral infection, according to a draft recommendation from the U.S. Preventive Services Task Force.

Hepatitis C remains major problem for HIV patients despite antiretroviral therapy

March 17, 2014
A new study led by researchers at the Perelman School of Medicine at the University of Pennsylvania has found that the risk of hepatitis C-associated serious liver disease persists in HIV patients otherwise benefitting from ...

Recommended for you

New long-acting approach for malaria therapy developed

January 22, 2018
A new study, published in Nature Communications, conducted by the University of Liverpool and the Johns Hopkins University School of Medicine highlights a new 'long acting' medicine for the prevention of malaria.

Virus shown to be likely cause of mystery polio-like illness

January 22, 2018
A major review by UNSW researchers has identified strong evidence that a virus called Enterovirus D68 is the cause of a mystery polio-like illness that has paralysed children in the US, Canada and Europe.

Creation of synthetic horsepox virus could lead to more effective smallpox vaccine

January 19, 2018
UAlberta researchers created a new synthetic virus that could lead to the development of a more effective vaccine against smallpox. The discovery demonstrates how techniques based on the use of synthetic DNA can be used to ...

Study ends debate over role of steroids in treating septic shock

January 19, 2018
The results from the largest ever study of septic shock could improve treatment for critically ill patients and save health systems worldwide hundreds of millions of dollars each year.

New approach could help curtail hospitalizations due to influenza infection

January 18, 2018
More than 700,000 Americans were hospitalized due to illnesses associated with the seasonal flu during the 2014-15 flu season, according to federal estimates. A radical new approach to vaccine development at UCLA may help ...

Flu may be spread just by breathing, new study shows; coughing and sneezing not required

January 18, 2018
It is easier to spread the influenza virus (flu) than previously thought, according to a new University of Maryland-led study released today. People commonly believe that they can catch the flu by exposure to droplets from ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.