The Alaska Native/American Indian experience of hepatitis C treatment with sofosbuvir-based direct-acting antivirals

HCC surveillance in hepatitis C: A longitudinal algorithm improves alpha-fetoprotein screening

BACKGROUND

Surveillance for HCC remains important after hepatitis C cure. Improved sensitivity of screening with alpha-fetoprotein (AFP) by using a parametric empirical Bayes (PEB) algorithm, which incorporates an individual patient's longitudinal AFP measurements, was previously demonstrated in a retrospective analysis of clinical trial data prior to widespread hepatitis C cure.

METHODS

We analyzed de-identified data extracted from the medical records of participants in the Alaska Hepatitis C Study, which aims to enroll all Alaska Native persons living in Alaska with a history of hepatitis C.We compared the performance characteristics of AFP as a screening test using the PEB method versus a fixed cutoff (FC) method in an observational setting, separately for HCC surveillance in active and cured hepatitis C.

RESULTS

The PEB and FC methods were applied to AFP levels from participants with F3/F4 fibrosis who had active hepatitis C (173 no HCC, 14 HCC) or after they achieved hepatitis C cure (162 no HCC, 12 HCC). Compared to a fixed 20 ng/mL cutoff, demonstrating 91.2% specificity in active hepatitis C, PEB increased sensitivity from 64.3% to 71.4%. After cure, a fixed 7.2 ng/mL cutoff demonstrated 91.2% specificity, and PEB increased sensitivity from 58.3% to 91.7%.

CONCLUSIONS

The PEB algorithm can increase sensitivity and lead to earlier detection of HCC among patients with F3/F4 fibrosis, both in active and even more so in cured hepatitis C. Lower AFP levels after cure indicate that for either PEB or FC methods, screening parameters, such as cutoffs for a target specificity, should be specified separately by hepatitis C treatment status for HCC surveillance.

Newly Reported Chronic Hepatitis C Among Adults - Alaska, 2016-2023

Hepatitis C virus is a leading cause of chronic liver disease, hepatocellular carcinoma, and liver-related death and is targeted for global elimination as a public health threat by 2030. Universal screening is recommended for all adults aged ≥18 years and pregnant women during each pregnancy; periodic risk-based screening also is recommended. Persons with current infection should be linked to antiviral treatment, which usually results in a virologic cure within 8-12 weeks. To assess progress toward elimination, epidemiologic trends in newly reported chronic hepatitis C cases were assessed among adult Alaska residents during 2016-2023. Overall, 5,352 confirmed chronic hepatitis C cases were newly reported among adults aged ≥18 years. The average annual rate (cases per 100,000 population) was 121 and decreased a relative 30% from 142 during 2016-2019 to 99 during 2020-2023. Statistically significant decreases occurred for most groups. Groups with higher average rates included males, adults aged 18-39 years, residents of rural areas, and American Indian or Alaska Native persons. Hepatitis C surveillance can help monitor trends in health outcomes and identify groups needing tailored testing and treatment interventions toward hepatitis C elimination.

Hepatitis C Virus Elimination in the United States: Challenges, Progress, and Future Steps

Hepatitis C virus (HCV) infection is a major public health challenge with a simple, highly efficacious, all-oral therapy (direct-acting antivirals) that can achieve cure. Owing to the ease of treatment, the World Health Organization outlined goals to eliminate HCV by the year 2030. However, unforeseen challenges have hampered progress, and few countries are on track to meet these goals. Significant disparities remain among priority populations because of barriers to care on the systemic, provider, and patient levels. In turn, many local, state, and national organizations have been persistent in tackling these barriers, the greatest of which is linkage to care. In 2023, the White House launched a multipronged national initiative to eliminate HCV infection. The resulting economic impact of the national HCV elimination program is estimated to yield a significant net cost savings of $18.1 billion within a 10-year period. This article addresses the barriers to HCV care in different priority populations and discusses innovative models of HCV care that have been introduced in the United States.