The Grand Rounds, opened by CDC Director Dr. Tom Frieden, set the stage for the National Summit, providing an update on how far we have come in just 25 years in our efforts to address HCV. Beginning with the changing epidemiology–from the high point of some 380,000 new HCV infections in 1989, annual rates of new HCV infections have fallen to an estimated 16,500 infections in 2011. Treatment for HCV has also evolved substantially, from early efforts which resulted in cures for only a small percentage of patients who could tolerate the prescribed 48-week therapy to the newer, better tolerated, shorter duration treatments which are able to cure a majority of patients. More new drugs are still in development, some of which show promise of 100 percent cure rates after as little as six weeks of therapy. In this timeline, many highlights and milestones from the past 25 years of HCV discovery are featured. But there is still much work to be done in order to realize the full potential promised by these scientific advances.
The National Summit began where the Grand Rounds left off and was, in the words of its convener, Dr. John Ward, Director of the CDC's Division of Viral Hepatitis, "A summit for action!" In the U.S., an estimated 3.2 million people are chronically infected with HCV but, the CDC estimates, only half of them are aware of their status. Of those, it is estimated that only 5-6 percent have been successfully treated and cured. Many challenges remain in diagnosing and treating those already infected. Summit presenters included CDC and other federal agency experts, academic researchers, health department leaders, advocates, and other stakeholders who shared multiple analyses and strategies currently being developed and implemented to improve diagnosis, care, and treatment for HCV—all in line with the Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis, the updated national plan addressing viral hepatitis in the United States.A growing body of evidence is informing these ongoing efforts, including cost effectiveness studies illustrating that diagnosing and treating chronic HCV is cost effective and comparable, in terms of cost effectiveness, to many other healthcare interventions such as cholesterol screening and mammograms for women older than 40 years of age. Updated treatment guidelines have been developed by experts in the field who are committed to continuing to share guidance about how best to use newly approved treatments with all healthcare providers, in an effort to help patients access new, lifesaving therapies. Additionally, policies that support the public health goals of reducing morbidity and mortality related to HCV were presented and discussed.
The observance of this 25th anniversary of the discovery of HCV included recognition of the work of the scientists who first discovered what was originally identified as “non-A, non-B viral hepatitis,” Harvey Alter, MD and Dan Bradley, PhD. These men, then scientists with NIH and CDC, made major contributions toward identifying the virus and toward preventing its spread via blood transfusion which was a primary route of transmission for most of the latter half of the 20th century.
Although screening the blood supply and implementation of universal precautions in health care settings have greatly reduced the rates of new HCV infections in the United States, the CDC has recently identified an uptick in HCV transmission among young people who use drugs (read a related post, “Hepatitis C Infection Among Young Injection Drug Users: Addressing an Emerging Trend”). Therefore we must continue to develop, evaluate, and disseminate effective new prevention interventions for this at-risk population if we are to realize the end of HCV. Presenters shared prevention strategies that have shown to be effective with people who use drugs including the use of new, extremely effective therapies for those most likely to transmit to others, often called 'treatment as prevention.'
Scientific advances, sustained public health focus, and the work of many advocates and people living with HCV have paved the way to where we are today. We have effective diagnostic tools and treatments, and more people than ever before are becoming aware of the importance of testing, care, and treatment for HCV. Although more work remains to be done, without a doubt, we have much to celebrate as we observe the 25th anniversary of this important public health discovery.