‘Jarringly’ Low Hep C Cure Rates a Decade After New Treatments, CDC Says

Only one in three U.S. adults infected with hepatitis C virus (HCV) have been cured since direct-acting antivirals became available 10 years ago, CDC data showed.

Among 1 million adults with evidence of initial infection using 2013-2022 national HCV testing data, only 34% had viral clearance of their infection, despite a national goal of over 80% achieving clearance by 2030, reported Carolyn Wester, MD, of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and colleagues.

Moreover, only 16% of people under the age of 40 without health insurance were cured, Wester and team noted in the Morbidity and Mortality Weekly Report.

“We found jarringly low cure levels across the board,” Wester said during a press briefing on Thursday.

The prevalence of being cured or cleared was lowest among those ages 20 to 29 (24%), and highest among those ages 60 and over (42%). People with other, unspecified, or Medicaid insurance had lower viral clearance (23%, 33%, and 31%, respectively) compared with those with Medicare and commercial insurance (40% and 45%, respectively).

Lack of diagnosis and treatment costs are both to blame, in addition to restrictive treatment coverage policies by payers, the researchers said.

In the U.S., an HCV diagnosis requires an antibody test followed by a lab-based nucleic acid test to confirm infection. “This process is cumbersome, results in some people never getting a confirmed diagnosis, and delays treatment,” the CDC said in a press release, adding that rapid point-of-care viral tests are needed.

Wester pointed out that “health coverage policies often make it difficult for people with hepatitis C to access treatment due to the high cost of treatment.”

“Some payers limit which patients are eligible for treatment or require burdensome pre-authorization before treatment can begin, or even limit the types of providers who can prescribe treatment,” she explained. “All of these restrictions can delay or even prohibit access to this life-saving medication.”

Over 2 million people in the U.S. have HCV, according to estimates from the CDC. About 1 million of these people are not aware and have mild symptoms, but infection can lead to liver damage and can cause liver cancer, liver failure, and death. HCV is spread through contact with blood from an infected person, often by sharing needles or other equipment used to prepare and inject drugs.

“Hepatitis C is a silent killer,” Wester said. “While this study looked at treatment gaps among people with diagnosed hepatitis C, there is also a great need to increase screening and testing.”

“Everyone with hepatitis C deserves the chance to be cured,” she added.

While HCV can be treated with a once-daily oral direct-acting antiviral taken for 8 to 12 weeks, resulting in cure in most cases, “these findings highlight the disproportionate need for increased access to hepatitis C treatment and prevention services among younger adults,” Wester and co-authors wrote.

At Thursday’s press briefing, Francis Collins, MD, PhD, who serves as the lead of the White House National Hepatitis C Elimination Program, noted that “the cure that’s been around now for 10 years is very simple. A lot of people remember the bad old days when the treatment for hepatitis C was very toxic and didn’t always work involving interferons.”

“That is not the case now,” he added. “We have the tools to win a victory here.”

The Viral Hepatitis National Strategic Plan calls for ≥80% of people with hepatitis C to achieve viral clearance by 2030. Rapid tests are a big part of achieving this goal, researchers said. In Europe and Australia, rapid tests are already available.

“Initiating this program would save the federal government more than $13 billion just in the first 10 years and $44 billion in 20 years,” Collins said, adding that cost savings would come from a reduction in liver transplants and liver cancer treatment.

“It’s rare to have both an opportunity to save lives and save money, but that’s what we have here. You can’t know this and just walk away,” he noted.

This analysis included 1,719,493 people ever infected with HCV from January 2013 to December 2022. Of these individuals, 29% were ages 20 to 39, 43% were ages 40 to 59, and 27% were 60 and older; 60% were men. About half were covered by commercial health insurance, 23% by other payer, 11% by Medicaid, 9% by an unspecified payer, and 8% by Medicare.

Over this time period, 88% of those ever infected were classified as having received viral testing; among those who received viral testing, 69% were classified as having initial infection; among those with initial infection, 34% were classified as cured or cleared (treatment-induced or spontaneous); and among those, 7% were categorized as having persistent infection or reinfection.

Study results were limited to people with a positive HCV test, Wester and team noted.