WHO highlights ‘unaffordable’ Hepatitis C treatments

The World Health Organization (WHO) has issued its first guidance for the treatment of hepatitis C, a chronic infection that affects an estimated 130 million to 150 million people and results in 350 000 to 500 000 deaths a year.

The guidelines cover the screening, care and treatment of persons with hepatitis C infection (HCV), and were launched on the eve of the opening of the 2014 International Liver Congress in London.

The publication of the WHO Guidelines for the screening, care and treatment of persons with hepatitis C infection coincides with a wave of new oral treatments for hepatitis, which promise to be more effective and have fewer side effects.

The most notable recent examples are Janssen-Cilag's Olysio (approved in the US but pending a decision in Europe) and Gilead's Sovaldi. These new oral drugs are able to cure almost all patients of the disease (in combination with standard treatment), increasing the cure rate in patients and also cutting the length of treatment needed.

But the high cost of the drugs is causing concerns about access in rich and poor countries alike.

WHO has addressed the issue directly, and says it will provide support to countries to implement its new guidelines, and will "assist to make the new treatments available and consideration of all possible avenues to make them affordable for all."

The global health organisation said it would also assess the quality of hepatitis laboratory tests and generic forms of hepatitis medicines.

"Hepatitis C treatment is currently unaffordable to most patients in need. The challenge now is to ensure that everyone who needs these drugs can access them," says Dr Peter Beyer, Senior Advisor for the Essential Medicines and Health Products Department at WHO. "Experience has shown that a multi-pronged strategy is required to improve access to treatment, including creating demand for treatment. The development of WHO guidelines is a key step in this process."

Undiagnosed disease

One of the main problems with hepatitis infections is that people can live with the infection for decades without becoming aware of it. When symptoms of the disease do appear, the damage to the liver can be very severe and potentially life-threatening.

There are five main hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis B and C have the greatest public health impact because they cause chronic infection which can progress to cirrhosis and liver cancer. Hepatitis A and E, spread though unsafe water and contaminated food, have the potential to cause outbreaks in certain populations.

Hepatitis C virus is most commonly transmitted through exposure to contaminated blood. Those at risk include people undergoing invasive medical procedures and therapeutic injections where there is poor infection control. Also at risk are those exposed to contaminated injecting and skin piercing equipment, including through injecting drug use, tattooing and body piercing.

The new guidelines make nine key recommendations. These include approaches to increase the number of people screened for hepatitis C infection, advice as to how to mitigate liver damage for those who are infected and how to select and provide appropriate treatments for chronic hepatitis C infection.

Screening: WHO recommends a screening test for those considered at high risk of infection, followed by another test for those who screen positive, to establish whether they have chronic hepatitis C infection.

Mitigating liver damage: Since alcohol use can accelerate liver damage caused by hepatitis C, WHO now advises that people with chronic hepatitis C infection receive an alcohol assessment. The Organization also recommends providing counselling to reduce alcohol intake for people with moderate or high alcohol use. In addition, the guidelines provide advice on the selection of the most appropriate test to assess the degree of liver damage in those with chronic hepatitis C infection.

Treatment: The guidelines provide recommendations on existing treatments based on interferon injections as well as the new regimens that use only oral medicines. WHO will update recommendations on drug treatments periodically as additional antiviral medicines are registered on the market and new evidence emerges.

Prevention: The 2014 recommendations also summarise for policy makers and health care workers interventions that should be put in place to prevent transmission of hepatitis C, including measures to assure the safety of medical procedures and injections in health care settings and among persons who inject drugs. Rates of new hepatitis C infections remain unacceptably high in many countries because of the reuse of injection equipment and lack of screening of blood transfusions.

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