Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications

PLoS One. 2021 Sep 16;16(9):e0257369. doi: 10.1371/journal.pone.0257369. eCollection 2021.

Abstract

Australia was one of the first countries to introduce government-funded unrestricted access to direct-acting antiviral (DAA) therapy, with 88,790 treated since March 2016. However, treatment uptake is declining which could potentially undermine Australia's progress towards the WHO HCV elimination targets. Using mathematical modelling, we updated estimates for those living with chronic HCV in Australia, new cases of decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and liver-related mortality among the HCV-cured and viraemic populations from 2015 to 2030. We considered various DAA treatment scenarios incorporating annual treatment numbers to 2020, and subsequent uptake per year of 6,790 (pessimistic), 8,100 (intermediate), and 11,310 (optimistic). We incorporated the effects of excess alcohol consumption and reduction in progression to DC and HCC among cirrhosis-cured versus viraemic individuals. At the end of 2020, we estimated 117,810 Australians were living with chronic HCV. New cases per year of DC, HCC, and liver-related mortality among the HCV viraemic population decreased rapidly from 2015 (almost eliminated by 2030). In contrast, the growing population size of those cured with advanced liver disease meant DC, HCC, and liver-related mortality declined slowly. The estimated reduction in liver-related mortality from 2015 to 2030 in the combined HCV viraemic and cured population is 25% in the intermediate scenario. With declining HCV treatment uptake and ongoing individual-level risk of advanced liver disease complications, including among cirrhosis-cured individuals, Australia is unlikely to achieve all WHO HCV elimination targets by 2030.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Australia / epidemiology
  • Calibration
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / drug therapy
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / mortality
  • Disease Progression
  • Epidemics
  • Epidemiological Monitoring
  • Hepacivirus
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / epidemiology*
  • Hepatitis C, Chronic / mortality
  • Hepatitis C, Chronic / prevention & control*
  • Humans
  • Incidence
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / mortality
  • Liver Neoplasms / complications
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / mortality
  • Models, Theoretical
  • Prevalence
  • Treatment Outcome
  • World Health Organization

Substances

  • Antiviral Agents

Grants and funding

The Kirby Institute is funded by the Australian Government Department of Health and is affiliated with the Faculty of Medicine, UNSW Sydney. The views expressed in this publication do not necessarily represent the position of the Australian Government. GJD has received research grant funding from Gilead, Merck, and Abbvie. JG has received research grant funding from Camurus, Cepheid, Gilead, Hologic, Indivior, Merck, and Abbvie unrelated to this work. JG is supported by an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (#1176131). Funders did not have any additional role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript. The specific roles of each author are articulated in the ‘author contributions’ section.