UNDERDIAGNOSIS AND UNDERTREATMENT OF HBV AND HCV: HOW DO WE SOLVE THIS?
July 25, 2017 - MCI Canada
Viral hepatitis is a major cause of death around the world, with mortality rates comparable to HIV/AIDS or malaria. With the availability of effective vaccines and treatments for Hepatitis B and a cure for Hepatitis C, their impact should be shrinking. Instead, HBV and HCV are increasing globally, eclipsing the effects of all other reportable infectious diseases. Two major reasons for rising HBV and HCV rates are underdiagnosis and undertreatment.
Why Hepatitis B and C are Underdiagnosed and Undertreated
An overwhelming 95 percent of people living with Hepatitis B or C are unaware of their condition; largely because the disease is often asymptomatic until later stages, but also due to a lack of routine screening.
Many patients do not seek or accept hepatitis screening because of inadequate knowledge about the risks involved with infection. Unfortunately, data shows physicians are often also unaware of HBV and HCV’s impact. In studies, only 60 percent of physicians adequately screened high-risk individuals, and many medical professionals incorrectly believed that only patients with abnormal liver tests needed screening.
Education for Patients and Physicians
Early diagnosis by screening for Hepatitis B and C gives many more patients the option to access life-saving treatment. HBV and HCV screening will increase with awareness, most powerfully spread through personal connections. A comprehensive city-wide program promoting HBV education, screening, and treatment in San Francisco saw 78 percent of individuals encourage family members to undergo screening within one year of being screened themselves.
The World Hepatitis Alliance initiative, NOhep, is using the power of online connections to increase awareness and move toward the next great health achievement: eliminating viral hepatitis by 2030. NOhep unites those working in the field of hepatitis and provides free HBV and HCV resources. Website visitors can pledge to get tested or vaccinated and share personal stories of HBV and HCV diagnoses, all geared towards influencing governments and reaching the UN’s Sustainable Development Goals.
Access and Adherence to Screening
Although the WHO recommends integrating hepatitis testing into national policy, mandatory widespread HBV and HCV testing is contentious. Earlier this year, recommendations for North American national testing strategies were labelled unethical because of financial strain on healthcare systems.
Most governments do agree on Hepatitis B and C testing of at-risk populations such as individuals with a history of IV drug use or unregulated blood transfusions. Consistent and meticulous screening of those most likely to be affected by the disease will go a long way in reducing HBV and HCV infection.
Holistic and Affordable Treatment
Access to affordable treatment will not only help resolve the controversy of widespread HBV and HCV testing, but also stop hepatitis infection from causing further health complications. Antiviral medicines can cure more than 95 percent of people with Hepatitis C, but cost remains a barrier. That being said, hepatitis treatment may still be more cost-effective than treating liver disease, 80 percent of which is caused by HBV and HCV.
In addition to drug therapies, patients should be connected with people-centered care across the service continuum. These services help address comorbidities and underlying factors that perpetuate HBV and HCV, including poverty, drug dependence, and poor mental health.
Research and Innovation
Appropriate diagnosis and treatment of Hepatitis B and C are limited with existing medicines, technologies, and delivery approaches. Research and innovation have the potential to dramatically change the trajectory of global hepatitis and improve the efficiency and quality of services.
Finding a cure for HBV is a top research priority. Available therapies already cause HBV viral loads to sink below detection, but an absolute cure will destroy the infection completely. There are two main barriers to finding a cure, and experts are optimistic that a foundation of discovery has been laid and a cure could be found in the next few years. Collaboration between researchers and policy-makers will help innovation translate into practice quickly and on the scale required to maximize impact.
As for HCV, newly developed interferon-free direct acting antivirals (DAAs) are highly outperforming past therapies, providing higher response rates, shorter therapy regimens, and fewer contraindications—even among previously difficult-to-treat patients.
Viral hepatitis is a global issue that needs to be addressed at both governmental and local levels. With better research, funding, education, and screenings, we can begin to diminish the widespread impact HBV and HCV have on the medical system and individuals’ health.
Photo: Shutterstock / sheff