A World Hepatitis Day reflection: making progress towards HCV treatment for children
Claire Thorne
Faculty of Population Health Sciences, University College London Institute of Child Health, UK
Today is World Hepatitis Day and the focus this year is on eliminating viral hepatitis.
An estimated 257 million people are living with chronic hepatitis B infection and 71 million have chronic hepatitis C, according to recent estimates published in the WHO Global Hepatitis Report 2017, with viral hepatitis ranking as the seventh leading cause of mortality worldwide, having caused 1.34 million deaths in 2015. This figure is comparable to tuberculosis mortality and higher than HIV mortality.
The WHO’s Global Strategy on Viral Hepatitis has the goal of eliminating viral hepatitis as a major public health threat by 2030 by:
- Reducing new cases of chronic hepatitis B and C by 90%;
- Reducing hepatitis B and C deaths by 65%;
- Treating 80% of eligible people with these chronic viral infections.
Nearly 200 governments worldwide have now adopted the Strategy. Today, on World Hepatitis Day 2017, there will be numerous awareness, testing and advocacy events worldwide with the goal of accelerating progress towards achieving the goal of elimination by 2030.
There are some major barriers to be overcome in order to reach such ambitious targets, including the prompt identification of people living with viral hepatitis infection – for example, only around 20% of people with chronic hepatitis C are diagnosed. Global access to hepatitis treatment and care services is a further challenge. Direct acting antivirals (DAAs) are potent, tolerable and highly efficacious in treating and curing hepatitis C, and their development was a precipitating factor for the WHO Global Strategy. However, in many parts of the world, these drugs remain unaffordable.
There have also been concerns that children are being 'left behind in the HCV treatment revolution' [1]. At least 3.5 million children aged 1–15 years are believed to be living with chronic HCV worldwide and, until very recently, the only options for treating children were the less effective and more toxic interferon-based therapies. Despite some positive regulatory changes in Europe, previously discussed in the Journal of Viral Eradication [2], the registration of DAA regimens for children has lagged substantially behind that of adults. However, a major milestone was reached in April, with the licensing by the US Food and Drug Administration of Sovaldi (sofosbuvir) and Harvoni (ledipasvir and sofosbuvir) to treat HCV in children from age 12 years. This welcome first step in drug access for children with chronic hepatitis C should be followed shortly by regulatory approval by the European Medicines Agency. Results are now also becoming available from paediatric clinical studies with DAAs, showing excellent rates of sustained virological response [3,4].
These developments are very welcome, as elimination of viral hepatitis as a public health threat will only be possible if children can benefit from the striking advances made in treating, and curing, hepatitis C over the past few years.
References
1. Indolfi G, Thorne C, El Sayed MH et al. The challenge of treating children with hepatitis C virus infection. J Pediatr Gastroenterol Nutr 2017; 64: 851–854.
2. Thorne C, Indolfi G, Turkova A et al. Treating hepatitis C virus in children: time for a new paradigm. J Virus Erad 2015; 1: 203–205.
3. Wirth S, Rosenthal P, Gonzalez-Peralta RP et al. Sofosbuvir and ribavirin in adolescents 12 to 17 years old with hepatitis C virus genotype 2 or 3 infection. Hepatology 2017.
4. Murray KF, Balistreri W, Bansal S et al. Ledipasvir/sofosbuvir ± ribavirin for 12 or 24 weeks is safe and effective in children 6–11 years old with chronic hepatitis C infection. EASL International Liver Congress. April 2017. Amsterdam, Netherlands. Abstract GS-010.