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PEER REVIEW: HEPATITIS C
Roadmap to Zero- The Elimination of Hepatitis C by 2030 Written by Nicola Perry, Secretary, Hepatitis C Partnership
Hepatitis C is an infection of the liver caused by the Hepatitis C virus, if left untreated it can cause permanent damage to the liver over many years. One in five people with liver damage associated with the virus will go on to develop Cirrhosis, which increases their risk of developing liver cancer.1 Most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs. From 2004 to 2019, 15,700 people in Ireland have been diagnosed with Hepatitis C. Each year around 600 to 700 people find out they have Hepatitis C and there could be as many as 30,000 people in Ireland living with the virus.2 To date, over 5,000 patients in Ireland have been treated with highly effective Direct Acting Antiviral DAA’s for hepatitis C.3
Programme (NHCTP), established in 2015. The programme specifics and structure is available on HseLand, and also in the NHCTP Community Treatment Guidelines, originally published in 2019. The document outlines preferred community DAA prescriptions as: Sofosbuvir/Velpatasvir 400mgs/100mg (Epclusa®) one tablet daily with or without food. Patient should be advised to take the medication at the same time every day. Pangenotypic 12-week course Suitable in all stages of hepatic impairment renally excreted (requires creatinine clearance > 30mls/min) Headache, fatigue and nausea are the most common side effects (> 10% of patients). They tend to be mild to moderate in severity. They are most likely to occur in the first four weeks of treatment.
In May 2016, the World Health Assembly adopted the first global health sector strategy on viral hepatitis, 2016-2021. Ireland is one of 194 Member States of the World Health Organisation committed to eliminating viral hepatitis as a public health threat by 2030.4 This ambitious strategy was made possible largely due to the introduction of Direct Acting Antiviral (DAAs) drugs in 2011. With a cure rate of ~96% these highly effective drugs with minimal side effects transformed HCV care globally. These drugs provided an opportunity to scale treatment largely due to the reduced monitoring and the increased efficacy they afforded. In Ireland the oversight of Hepatitis C treatment is carried out by the National Hepatitis C Treatment AUGUST 2022 • HPN | HOSPITALPROFESSIONALNEWS.IE
Glecaprevir/Pibrentasvir 100mgs/40mgs (Maviret®) three tablets once daily with or after food. Patient should be advised to take the medication at the same time every day. Pangenotypic 8-week course not suitable for Child Pugh’s stage B and C cirrhosis. Suitable in all stages of renal failure including dialysis Minimal side effects. Headache and fatigue most common. Also potential for GI symptoms particularly if patients do not take their medication with or after food. These treatments have >95% cure rate, for most patients are taken with minimal side effects, the drug cost is covered in the NHCTP. So why in some quarters does it appear Ireland, along with other EU countries is not on track to achieve the elimination of Hepatitis C by 2030?
A recent study done by Liver International in 2021 found, that out of 45 high-income countries, only 11 (Australia, Canada, France, Germany, Iceland, Italy, Japan, Spain, Sweden, Switzerland, and United Kingdom) countries are on track to meet the WHO’s global elimination strategy. Ireland, like 27 other member states, are predicted to achieve elimination by 2050, 20 years after the target date.5 Current data from the NHCTP suggests that Ireland has reached the 2020 targets and is on track to achieve 2030 WHO elimination targets.6 This is disappointing given the known risks of communicable diseases and the availability of highly effective curative treatments. The reasons for this are of course complex but in the simplest of terms, endemic barriers in the care cascade have resulted in many patients being lost to care. We at the Hepatitis C Partnership (HCP) undertook a national scoping exercise during 2021 to try to better understand the experiences of healthcare providers and people directly affected by Hepatitis C. We hoped to learn what was working well, what could be improved and what those at the centre of the Hep C cascade of care thought. The result of this extensive undertaking is “The Roadmap to Zero”, launched by the HCP on the 1st June of June 2022. The launch coincided with the opportunity to present the recommendations
