Nearly three-quarters of a million people die worldwide from complications related to hepatitis C virus (HCV). New HCV treatments using direct-acting antiviral (DAAs), cure more than 90 percent of those who use them. Generally, DAAs are tolerable with mild side effects. The all-oral treatment is usually only 12 weeks.
The World Health Organization (WHO) issued updated guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. The recommendations include the use of DAAs, rather than peginterferon plus ribavirin. WHO also recommended discontinuation of Incivek and Victrelis.
What WHO did not do was take a stand regarding HCV treatment prioritization. Unlike the HCV Guidelines provided by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), or the recommendations published by the European Association for the Study of the Liver (EASL), WHO took a pragmatic non-stand. I must confess that I am sympathetic to the complexities that WHO is up against. It is difficult enough to get treatment for citizens of the affluent United States; just imagine how hard it would be to pitch treatment for everyone in a country that is poor and has a high prevalence of HCV such as Pakistan, with over 9 million people with hep C.
Still, it is disappointing that WHO didn’t step up and say, “Everyone should be treated.” Triaging treatment isn’t going to get us to the goal of eradicating hep C in the world. We can cure hep C, but we need strong voices to lead the way.
Where is the U.S. in all of this? Rumor has it that the Institute of Medicine may be discussing an Eliminate Hep C campaign. This seems too good to be true, so I am not going to get too excited yet. Stay tuned to see if I am wrong. Wouldn’t it be wonderful if I am?