The Effective Management Of Hepatitis C Infection

Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the first of two, examines the feasibility of hepatitis B and C elimination in the United States and identifies critical success factors. The phase two report will outline a strategy for meeting the elimination goals discussed in this report.

Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviors and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination. These are the first WHO guidelines on testing for chronic HBV and HCV infection and complement published guidance by WHO on the prevention, care and treatment of chronic hepatitis C and hepatitis B infection. These guidelines outline the public health approach to strengthening and expanding current testing practices for HBV and HCV, and are intended for use across age groups and populations.

The global epidemic of hepatitis B and C is a serious public health problem. Hepatitis B and C are the major causes of chronic liver disease and liver cancer in the world. In the next 10 years, 150,000 people in the United States will die from liver disease or liver cancer associated with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Today, between 800,000 and 1.4 million people in the United States have chronic hepatitis B and between 2.7 and 3.9 million have chronic hepatitis C. People most at risk for hepatitis B and C often are the least likely to have access to medical services. Reducing the rates of illness and death associated with these diseases will require greater awareness and knowledge among health care workers, improved identification of at-risk people, and improved access to medical care. Hepatitis B is a vaccine-preventable disease. Although federal public health officials recommend that all newborns, children, and at-risk adults receive the vaccine, about 46,000 new acute cases of the HBV infection emerge each year, including 1,000 in infants who acquire the infection during birth from their HBV-positive mothers. Unfortunately, there is no vaccine for hepatitis C, which is transmitted by direct exposure to infectious blood. Hepatitis and Liver Cancer identifies missed opportunities related to the prevention and control of HBV and HCV infections. The book presents ways to reduce the numbers of new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis. It identifies priorities for research, policy, and action geared toward federal, state, and local public health officials, stakeholder, and advocacy groups and professional organizations.

In the past few years, remarkable progress has been made in our understanding of HCV biology, pathogenesis of infection, and structure-function relationships. This has led to quantum advances in clinical efficacy and tolerability. Yet, in spite of this amazing progress, there remain obstacles to widespread successful treatment. These issues include biological failures even with direct-acting agents, lack of options for individual with organ failures, drug-drug interactions, access to medications either due to lack of availability or affordability, and psychiatric and social issues. These problems are likely to remain in the future. Therefore, this book has been created by distinguished faculties from around the world to address the progress in our understanding of HCV infection and to review new treatment options, limitations, and accessibility of new therapeutic options.

Fueled in part by the opioid epidemic, the number of reported hepatitis C virus infections tripled in the United States between 2010 and 2015. As new infections continue to mount, new therapies have produced seismic changes in how HCV is treated clinically, leaving a gap between the most current clinical guidance and the ongoing demands of patient care. The New Hepatitis C is a current and essential review of HCV's epidemiology, diagnosis, and clinical approaches -- a clinician's guidebook for navigating everything from screening to treatment. Acute and chronic HCV are addressed, as are important new treatment options for HCV, management of side effects, and a convenient summary of clinical trials on the treatment of chronic hepatitis C. Updated to detail the standards of care that will define the next decade of HCV management, this evidence-based volume is an essential clinical reference for to any practitioner in gastroenterology, hepatology, infectious disease, transplant, or internal medicine.

Preceded by: Cost-effectiveness in health and medicine / edited by Marthe R. Gold ... [et al.]. New York: Oxford University Press, 1996.