CDC: Hepatitis C Treatment Declined in the US Between 2015 and 2020

By Jeff Craven, MD /alert Contributor
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Fewer people living with hepatitis C (HCV) initiated treatment with direct-acting antivirals (DAA) in the United States between 2015 and 2020, according to research recent presented at the 2021 American Association of the Study of Liver Disease and announced through a news release from the Centers for Disease Control and Prevention (CDC).

The number of people treated for HCV has been on the decline since 2015, the CDC said. In 2015, an estimated 164,247 patients with HCV initiated DAA treatment. However, the estimated number of people who received HCV treatment decreased in 2016 (134,287 patients) and 2017 (114,419 patients). While there was a slight increase in the number of patients with HCV treated with DAA in 2018 (122,666 patients), the number of estimated patients who received HCV treatment continued to decline in 2019 (114,893 patients) and 2020 (83,740 patients).

CDC noted these figures are “far short of national hepatitis C public health goals,” citing an estimate from the National Academies of Sciences, Engineering, and Medicine (NASEM) from 2015 that stated a minimum of 260,000 people living with HCV should receive treatment each year to eliminate HCV in the US by 2030. NASEM’s estimate from 2015 “is likely an underestimate of what is needed, given years of under-treatment coupled with the ongoing increases in new hepatitis C infections driven by the nation’s opioid crisis,” they said. 

While the number of people receiving treatment for HCV has decreased, barriers to accessing treatment such as policy restrictions at the state level have been removed, CDC said. In addition, the proportion of claims for hepatitis C DAAs paid for by Medicaid increased by three-fold between 2014 and 2020, they noted. The cost of treatment has also decreased “due to increased competition from drug makers, programs contracting for lower costs, and innovative state treatment models.”

Among the barriers that still exist for patients include restrictive Medicaid state policies on the types of providers who can treat HCV, patient sobriety requirements serving as deterrents, and prior authorization requirements, the CDC said.

The effort to eliminate HCV in the US has also been complicated by the COVID-19 pandemic. Stay-at-home orders, patients avoiding medical services where HCV testing is offered, and reduced hours at healthcare clinics and syringe service programs have “caused major disruptions in access to hepatitis C testing and treatment services,” the agency explained.

“Reaching more people with hepatitis C testing and treatment is critical to saving lives and preventing transmission of this deadly, but curable, infection,” CDC said. “Hepatitis C treatment can cure more than 90 percent of hepatitis C cases, but testing is a critical first step.”

The agency estimated that approximately 2.4 million people living with HCV in the US between 2013 and 2016. Between 2009 and 2019, acute HCV infection as reported to the CDC has quadrupled, and 67% of cases were attributed to injection drug use in 2019. About 40% of people currently living with HCV between 2015 and 2018 didn’t know they were infected, the agency noted.

“Harm reduction programs and intervention such as syringe services programs and substance use disorder treatment are essential to reduce bloodborne infections, including hepatitis C, among people who inject drugs,” CDC said. “Connecting people who inject drugs to hepatitis C testing and treatment services is critical to reducing hepatitis C transmission.”


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