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About 25% fewer patients with hepatitis C virus (HCV) were initiated on treatment in 2020 compared with 2019 due to the COVID-19 pandemic, though the WHO target for elimination may not be entirely out of reach, a researcher said.

If HCV programs are able to rebound from the pandemic and return to their original forecast, or even if they come back stronger following disruption, the U.S. would be estimated to avert 19,400 to 33,200 liver-related deaths from 2021 to 2030, reported Sarah Blach, MHS, of the CDA Foundation in Lafayette, Colorado, a nonprofit organization that helps to develop national strategies for hepatitis elimination.

However, if HCV programs continue to experience long-term disruptions, there will be no decline in the number of liver-related deaths or cases of hepatocellular carcinoma by 2030, and the number of HCV infections could be even greater than it is today.

As of 2019, the U.S. was not on target to eliminate HCV by 2030, per WHO targets or those set by CDC's national progress report on viral hepatitis, noted Blach at a press conference during the European Association for the Study of the Liver virtual meeting.

Two factors are at play: an increase in incident infections and "ongoing treatment restrictions on the basis of fibrosis stage or severity," she said.

From 2014 to 2019, about 1.2 million patients were treated for hepatitis C, leading to reductions of over 50% in hepatocellular carcinoma cases and reductions of over 65% in liver-related deaths in 2019 compared with 2014. Then the pandemic hit.

Blach noted that 160,000 to 170,000 patients were expected to be initiated on HCV treatment since 2019, but fewer than 150,000 patients have been started on therapy.

Blach's group evaluated three scenarios on HCV elimination efforts using an updated, previously validated Markov model with epidemiological data from the U.S. The first assumed the country never recovered from the pandemic and treatment and diagnosis efforts declined into the future; the second examined a recovery and return to previous treatment forecasts; and the third looked at increased momentum and achieving WHO targets.

Models from the second and third scenarios estimated that 780,000 to 2.3 million cumulative patients could be initiated on treatment if HCV programs either recovered from the pandemic disruption or achieved greater momentum.

The authors noted that achieving WHO elimination targets would require treating at least 240,000 patients per year and increasing access to harm reduction programs.

In addition, the second and third scenarios would also avert 9,500 and 24,900 cases of hepatocellular carcinoma, respectively, from 2021 to 2030 in comparison with the first scenario. At the press conference, Blach noted that the second scenario would not achieve WHO or CDC targets, but it would still be progress.

Both CDC and the U.S. Preventive Services Task Force now recommend screening all adults for hepatitis C, so the political will to make this happen is there, she said.

The country should not become complacent, she warned, adding that once patients are diagnosed, it is essential to link them to treatment and care.

"Ultimately whether or not the U.S. achieves [HCV] elimination" is up to everyone in the country to decide, she said.

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