Number of people treated for hepatitis C virus infection in 2014-2023 and applicable lessons for new HBV and HDV therapies
Homie Razavi, Imam Waked, Huma Qureshi, Loreta A. Kondili, Ann‐Sofi Duberg, Soo Aleman, Junko Tanaka, Jeffrey V. Lazarus, Daniel Low‐Beer, Zaigham Abbas, Antoine Abou Rached, Alessio Aghemo, Inka Aho, Ulus Salih Akarca, Said A. Al‐Busafi, Waleed K. Al‐Hamoudi, Khalid Al‐Naamani, Ahmed Sabry Alaama, Manahil M Aldar, Mohammed Alghamdi, Mónica Alonso González, Haleema Alserehi, Anil C. Anand, Tarik Asselah, Abdullah M. Assiri, Kostas Athanasakis, Rita Atugonza, Ziv Ben‐Ari, Thomas Berg, Carlos Eduardo Brandão‐Mello, A. Brown, Kimberly Brown, Robert S. Brown, Philip Bruggmann, Maurizia Rossana Brunetto, María Buti, Hugo Cheinquer, Peer Brehm Christensen, Vladimir Chulanov, Laura Garza, Carla S. Coffin, Nicola Coppola, Antonio Craxı̀, Javier Crespo, Fuqiang Cui, Olav Dalgård, Alethse de la Torre, Victor de Lédinghen, Douglas T. Dieterich, Sylvia Dražilová, Jean‐François Dufour, Mohamed El‐Kassas, Mohammed Elbadri, Gamal Esmat, Rafael Esteban Mur, Brandon Eurich, Diana Faini, Paulo Roberto Abrão Ferreira, Robert Flisiak, Soňa Fraňková, Giovanni Battista Gaeta, Ivane Gamkrelidze, Edward Gane, Virginia Garcia, Javier García‐Samaniego, Manik Gemilyan, Magnús Gottfreðsson, Michael Gschwantler, Ana Paula Maciel Gurski, Behzad Hajarizadeh, Saeed Hamid, Angelos Hatzakis, Julian Hercun, Ivana Hockicková, Jee‐Fu Huang, Béla Hunyady, Sharon Hutchinson, Naoko Ishikawa, Kiyohiko Izumi, Antonio Izzi, Martin Janíčko, Peter Jarčuška, Agita Jēruma, Asgeir Johannessen, Kulpash Kaliaskarova, Jia‐Horng Kao, Knut Boe Kielland, Nicolas Kodjoh, Shyamasundaran Kottilil, Pavol Kristián, Paul Y. Kwo, Martin Lagging, Hilton Y. Lam, Pablo Lázaro, Mei‐Hsuan Lee, Sabela Lens, Valentina Liakina, Young‐Suk Lim, Michael Makara, M.P. Manns
Abstract
BACKGROUND & AIMS: The year 2023 marked the 10-year anniversary of the launch of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV). Monitoring HCV treatment trends by country, region, and globally is important to assess progress toward the World Health Organization's 2030 elimination targets. Additionally, historical patterns can help predict the uptake of future therapies for other liver diseases. METHODS: The number of people living with HCV (PLHCV) treated between 2014-2023 across 119 countries was estimated using national HCV registries, reported DAA sales data, pharmaceutical companies' reports, and estimates provided by national experts. For the countries with no available data, the average estimate of the corresponding Global Burden of Disease region was used. RESULTS: An estimated 13,816,000 (95% uncertainty intervals: 13,221,000-16,415,000) PLHCV were treated, of whom 12,748,000 (12,226,000-15,231,000) were treated with DAAs, of which 11,081,000 (10,542,000-13,338,000) were sofosbuvir-based DAA regimens. Country-level data accounted for 97% of these estimates. In high-income countries, there was a 41% drop in treatment from its peak, and reimbursement was a large predictor of treatment. In low- and middle-income countries, price played an important role in expanding treatment access through the public and private markets, and treatment continues to increase slowly after a sharp drop at the end of the Egyptian national program. CONCLUSIONS: In the last 10 years, 21% of all HCV infections were treated with DAAs. Regional and temporal variations highlight the importance of active screening strategies. Without program enhancements, the number of treated PLHCV stalled in every country/region, which may not reflect a lower prevalence but may instead reflect the diminishing returns of existing strategies. IMPACT AND IMPLICATIONS: Long-term hepatitis C virus (HCV) infection can lead to cirrhosis and liver cancer. Since 2014, these infections can be effectively treated with 8-12 weeks of oral therapies. In 2015, the World Health Organization established targets to eliminate HCV by 2030, which included treatment targets for member countries. The current study examines HCV treatment patterns across 119 countries and regions from 2014 to 2023 to assess the impact of national programs. This study can assist physicians and policymakers in understanding treatment patterns within similar regions or income groups and in utilizing historical data to refine their strategies in the future.