Anna S. Lok, MD
University of Michigan, Ann Arbor, MI, USA
President, American Association for the Study of Liver Diseases
Anna S. Lok, MD
In response to the World Health Organization’s (WHO) strategic goal to eliminate hepatitis B and C by 2030, the United States National Academies of Sciences, Engineering and Medicine (NASEM) convened and released two reports in 2016 and 2017 confirming the feasibility of reaching the goal set by WHO and the actions that would be needed to accomplish that goal.
NASEM’s goal for hepatitis B is to decrease mortality from chronic hepatitis B by 50% and hepatitis B virus- (HBV) related hepatocellular carcinoma (HCC) by 33%, and to eliminate mother-to-child transmission of HBV by 2030. To accomplish this goal will require diagnosing 90% of chronic hepatitis B cases, bringing 90% of those diagnosed to care, and treating 80% of those for whom treatment is indicated. It would also require strict adherence to current recommendations to screen all pregnant women for hepatitis B and administration of birth dose HBV vaccine and hepatitis B immune globulin to newborns of HBV-infected mothers, plus antiviral therapy to HBV-infected mothers with high viremia during the third trimester of pregnancy.
The goal for hepatitis C is a 90% reduction in incidence and a 65% reduction in hepatitis C virus- (HCV) related mortality by 2030 (relative to 2015). Meeting this goal will require treatment without restrictions on severity of liver disease and a consistent ability to diagnose new cases. Enhancing diagnosis in high-risk populations, facilitating access to care, and alleviating societal stigma would also be needed. New strategies to lower the cost of direct-acting antiviral drugs were also proposed.
The American Association for the Study of Liver Diseases (AASLD), a sponsor of the NASEM deliberation, applauds the task force in their conclusion that elimination of hepatitis B and C in the United States is feasible and agrees with its recommendations on how to meet this goal. AASLD agrees that all stakeholders must collaborate to implement the NASEM recommendations and make elimination of hepatitis B and C a priority. Implementation of the NASEM recommendations will require commitment of resources (funding and manpower) and coordination by the highest level government agency.
As a professional society, AASLD’s key roles include: advocacy, education, capacity building, and research. AASLD will work with government agencies in particular the Centers for Disease Control and Prevention, patient societies and local communities to raise public awareness about hepatitis B and C. AASLD will continue to advocate for support from federal and state governments to provide the services needed to expand screening, linkage to care, vaccination and harm reduction; to improve current surveillance system to provide more accurate data on disease burden including burden of HBV- and HCV- related HCC; to provide funding for research towards a vaccine for HCV and a cure for HBV; and to facilitate access to affordable HBV and HCV treatment.
Implementation of NASEM recommendations will require a pool of trained providers and care-navigators in the community, AASLD is poised as we have in our portfolio a wide array of educational materials catered for primary care providers and more than 5,000 members spread across the country.
AASLD will continue to advocate for increased funding for research. AASLD and the AASLD Foundation have been strong supporters of research in liver diseases and training of hepatology providers. In 2017, $3.4 million of training and career development awards were provided and new categories of grant funding will be added in 2018. While the goal of elimination of any disease might seem ambitious and daunting, AASLD is optimistic that together we can achieve the goal of eliminating hepatitis B and C in the United States and globally by 2030. Commitment and collaboration will be the key to make this goal a reality.