Hepatitis C Virus Statistics
The Centers for Disease Control and Prevention (CDC) estimates the overall incidence of Hepatitis C in the United States is 0.3 per 100,000. Additionally, CDC surveillance data shows the incidence of cases of acute HCV infection reported among individuals younger than 30 years old rose from 2006 to 2012 by 13 percent annually in non-urban counties. The increase among young individuals most likely reflects an increase in intravenous drug use.
Most cases of acute HCV infection are anicteric and asymptomatic, with less than twenty-five percent presenting clinically. However, patients that develop a chronic HCV infection will develop cirrhosis, and a subset of those patients will develop hepatocellular carcinoma.
Cost of Treating Hepatitis C
Today, the total cost is estimated at $6.5 ($4.3-$8.4) billion and it will peak in 2024 at $9.1 ($6.4-$13.3) billion. Antiviral therapies have rapidly evolved in the recent decade, with the introduction and development of direct-acting antivirals that provide interferon-free (and in some cases, interferon- and ribavirin-free) regimens for the majority of HCV patients. Treatment selection varies by genotype and other patient factors. Direct antiviral medications target specific molecular constructs of the virus.
- Sofosbuvir is a nucleoside polymerase inhibitor that works for all 6 genotypes of HCV, has a very high barrier to resistance, and few expected drug-drug interactions
- Dasabuvir is a non-nucleoside polymerase inhibitor. It is less potent and has a lower threshold for resistance than other classes; its main role will likely be as an adjunctive drug to a more potent compound with higher barriers to resistance
- Ledipasvir and ombitasvir are well-tolerated NS5A inhibitors that are available in fixed-dose combinations with other direct-acting antivirals. Daclatasvir is an NS5A inhibitor in the late stages of development.
Treatment of Treating Hepatitis C and Hepatitis C Virus Resistance
Several direct-acting antivirals are only available as part of fixed-dose combinations. These are ledipasvir-sofosbuvir and ombitasvir-paritaprevir-ritonavir, which are administered with dasabuvir. This includes the newer drug Harvoni, which is a fixed-dose combination of ledipasvir-sofosbuvir. Harvoni is susceptible to NS5A mutations that reduce susceptibility to ledipasvir, most commonly Q30R, Y93H/N, and L31M in subtype 1a virus and Y93H in subtype 1b virus. Approximately 20 percent of genotype 1 viruses harbor polymorphisms that confer reduced susceptibility to ledipasvir, but preliminary data suggest pre-existing resistance-associated polymorphisms may not affect efficacy of ledipasvir-sofosbuvir in the treatment-naïve patients. Further data are needed. Currently, there are no available tests for NS5A mutations commercially available in the US.