In France, an estimated 160 000 people are living with hepatitis C virus, 75 000 of whom have yet to be diagnosed. In the new context of a treatment accessible to all those infected, we now have the means to end the epidemic in France. We have very effective individual and collective treatments. Each patient can henceforth be treated irrespective of the level of infection and experience undeniable individual benefits. Collectively, universal treatment suggests that it is possible to reduce the number of patients likely to transmit the infection.
This new situation implies that we should increase screening to maximize the number of people aware of their serological status. To achieve this, we need to negotiate numerous obstacles related to social, cultural, behavioral and other factors.
It is also possible to act on people's behavior to reduce exposure to the risk of infection. This is particularly true for so-called vulnerable populations like drug users, prisoners, migrants, mobile populations, and men who have sex with men.
It is also known that some French departments, such as French Guiana, are more affected than others.
"The efficacy of treatments against HCV is now established"
While new direct-acting antivirals are highly effective against hepatitis C virus, not all patients respond positively: some are resistant to these drugs; others, more severely ill, develop hepatic tumors despite eradication of the virus.
Lastly, we still have no effective vaccine to protect against HCV infection, despite efforts supported in numerous countries, including France.
"We can eradicate hepatitis C if we increase screening and prevention"
In France, the prevalence of hepatitis B is high in certain exposed populations, such as drug users, prisoners, and people born in countries of high endemicity. Infection in the general population principally concerns young adults, usually because of risky sexual behavior.
"New HBV infections despite an effective vaccine"
Most infections could have been avoided had vaccine recommendations been better applied because, unlike for hepatitis C, we have a vaccine effective against hepatitis B.
The natural history of hepatitis B at the chronic stage is marked by serious complications, such as cirrhosis of the liver and hepatocellular carcinoma. The main aim of all treatments is to prevent disease progression to such complications. This can be achieved if viral suppression is prolonged, which is possible with current treatments. Viral suppression enables remission of infection and prevents complications, but a cure, like that of hepatitis C, is rarely achieved, which means that treatment must be continued.
In the fight against hepatitis, there are many challenges facing basic, clinical, social sciences research and representative communities. These are identifying the individual and organizational obstacles to screening, facilitating screening among the most exposed populations, evaluating the outcome of patients who have received treatment, defining the best possible therapeutic strategies, and improving epidemiological surveillance, leading to curative treatment of hepatitis B and a vaccine against hepatitis C.
Worldwide, 130 to 150 million people have chronic HCV infection and about 240 million HBV infection. The regions most affected by hepatitis C are Africa and Central and East Asia. Sub-Saharan Africa and East Asia have the highest prevalence of hepatitis B.
"Awareness-raising in resource-limited countries of the importance of the endemic"
Some resource-limited countries have set up national viral hepatitis programs, reflecting awareness of the gravity of the epidemic and the need to inform populations, to undertake screening and prevention programs, and to treat patients.
The challenges facing research in resource-limited countries are the need for improved understanding of the dynamics of epidemics and of the natural history of chronic hepatitis, the care of advanced forms of liver disease, in particular linked to HIV co-infection, and the roll-out of prevention and screening programs adapted to the social, cultural, and economic context.