ARTICLE: The HCV care continuum does not end with cure: A call to arms for the prevention of reinfection

AUTHORS: Oluwaseun Falade-Nwulia and Mark Sulkowski

JOURNAL: J Hepatol. 2016 Nov 2. pii: S0168-8278(16)30636-5. doi: 10.1016/j.jhep.2016.10.027. [Epub ahead of print]

After the approval of safe and highly effective oral direct acting agents (DAA) for the treatment of hepatitis C virus (HCV) in 2014, commentaries and discussions about the elimination of hepatitis C on a population level have rapidly proliferated in scientific literature and popular press. Indeed, the World Health Organization (WHO) has announced proposed global targets of an 80% reduction in new cases of HCV infection from the 2010 level and several countries, including Australia, Egypt, Georgia and Iceland have embarked on ambitious plans to control HCV infection in their populations [1].

The launch of such programs has led to increased focus on the hepatitis C care continuum with particular emphasis on the identification of HCV-infected persons and linkage of such persons to HCV care and treatment to achieve HCV cure. Modeling data from multiple groups provide the basis for optimism and suggest that the crucial step in reducing the prevalence of HCV infection over a period of time is an increase in HCV treatment uptake in key populations [2] and [3]. In particular, persons living with HIV infection represent a population for whom HCV control has been prioritized due to the high prevalence of HCV infection and high burden of HCV-related morbidity and mortality. Further, ongoing global efforts to improve the HIV care continuum, linking HIV-infected persons to long-term antiretroviral therapy provide an ideal foundation on which to launch concerted efforts to eliminate HCV coinfection. As these programs take shape, it is important to recognize that the HIV and HCV care continuum are not identical. In the absence of HIV cure, patients must continue antiretroviral therapy indefinitely, whereas HCV treatment is finite and curative. However, in the absence of an effective HCV vaccine, persons cured of chronic HCV are at-risk for reinfection if exposed. Thus, the HCV care continuum does not end with cure; and the prevention of reinfection must be addressed in persons at-risk (Fig. 1). To date, relatively high rates of reinfection with hepatitis C following cure have been observed in two patient groups: People who inject drugs (PWID) and HIV-infected men who have sex with men (MSM) [4][5][6] and [7].

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