Professor Wang Lei: Preventing the 'Silent Killer' Hepatitis C Requires Cutting Off Transmission at the Source

Director Wang Lei, Hepatitis C Specialist at the Second Hospital of Shandong University

Since hepatitis C was discovered less than 30 years ago, often presents with no obvious symptoms in its early stages, and is not included in routine health check-ups, many people have limited awareness of it compared to hepatitis B. Unless individuals undergo targeted screening or the infection is incidentally detected during other medical examinations, hepatitis C is easily missed in diagnosis, becoming a significant “ticking time bomb” in the body that patients often overlook.

In fact, as a “silent killer,” hepatitis C has been listed as a common infectious disease in China and is posing a serious threat to the health of the Chinese population.

It is understood that hepatitis C is caused by infection with the hepatitis C virus (HCV) and is primarily transmitted through blood or bodily fluids. According to estimates from the World Health Organization, approximately 180 million people worldwide are infected with HCV, resulting in about 400,000 deaths annually. In China, the current prevalence of anti-HCV positivity among the healthy population is 0.43%. When high-risk groups—such as former professional plasma donors, individuals undergoing hemodialysis, people who inject drugs, and those engaging in high-risk sexual behaviors—are included, nearly 10 million people are currently threatened by hepatitis C.

Due to various factors, including the biological characteristics of the virus and host immune function, the body’s immune system often fails to effectively clear the hepatitis C virus (HCV). As a result, approximately 50%–80% of HCV-infected individuals progress to chronic hepatitis, among whom 20%–30% will develop liver cirrhosis. Furthermore, 1%–4% of patients with liver cirrhosis progress to hepatocellular carcinoma each year.

Although the current epidemiological situation of hepatitis C is already very severe, public education and prevention and control efforts for hepatitis C remain a major challenge in the field of social public health. To address this, the author interviewed Director Wang Lei, a hepatitis C specialist at the Second Hospital of Shandong University, to gain insights into the current status of hepatitis C treatment and prevention and control efforts in China.

The development and progress of any endeavor inevitably involve a prolonged process, and the treatment of hepatitis C is no exception. According to Director Wang Lei, acute hepatitis C easily progresses to the chronic stage. Chronic hepatitis C continues to advance and can develop into liver cirrhosis or even hepatocellular carcinoma; therefore, active antiviral therapy should be administered. Hepatitis C can be cured through antiviral treatment. Its therapeutic regimens have evolved from early standard interferon monotherapy, to standard interferon combined with ribavirin, and further to pegylated interferon plus ribavirin, which was once regarded as the “standard of care.”

However, this “standard treatment” approach has its limitations. First, the cure rate is not particularly high. In China, the cure rate is relatively higher, exceeding 70–80%, whereas in other countries it is only around 60–70%. Second, this therapy is associated with numerous adverse reactions. For instance, interferon can cause fever of varying severity, as well as decreases in white blood cell and platelet counts. It may also lead to changes in thyroid function. In some patients with decompensated liver function, the condition may even worsen after medication. These significant side effects limit the clinical application of this treatment modality, and it is contraindicated in patients who have undergone organ transplantation. Third, regarding treatment duration and cost, the regimen typically lasts 24–48 weeks, with some patients requiring up to 72 weeks. The relatively prolonged treatment course necessitates not only medication expenses but also frequent follow-up examinations, resulting in a substantial overall financial burden.

It is reported that, since 2015, European guidelines have no longer recommended the so-called “standard therapy” regimen of pegylated interferon combined with ribavirin, which is associated with lower cure rates and greater toxic side effects. With the market introduction of more direct-acting antiviral agents for hepatitis C, all interferon-containing regimens were removed from the guidelines starting in 2016. Meanwhile, treatment protocols in China are also undergoing transformative updates, and the management of hepatitis C is gradually entering an interferon-free era.

Since the advent of sofosbuvir in 2013, Gilead Sciences has successively undergone drug iterations and upgrades in the treatment of hepatitis C, including sofosbuvir, the “second-generation” Harvoni, the “third-generation” Epclusa, and the “fourth-generation” Vosevi, which was just approved by the U.S. FDA in 2017.

This has brought new hope for treatment to hepatitis C patients. As the first pan-genotypic medication for hepatitis C, Epclusa was approved by the National Medical Products Administration on May 23, 2018, for use in China to treat adult patients infected with chronic hepatitis C virus (HCV) genotypes 1–6.

Director Wang Lei stated that, currently, Epclusa, manufactured by Gilead Sciences, is the most effective medication for treating hepatitis C virus (HCV). Its most significant advantage lies in its pangenotypic profile, demonstrating efficacy against various HCV genotypes, mixed genotypes, and cases with unknown genotypes. In terms of treatment duration, Epclusa offers a clear benefit: regardless of the HCV genotype with which a patient is infected, the standard course of therapy is 12 weeks. This uniformity applies even to patients with genotype 3, which is typically more challenging to treat, thereby simplifying clinical management for physicians. Furthermore, Epclusa is suitable for patients with decompensated cirrhosis and exhibits minimal drug-drug interactions with medications taken for comorbid conditions. Consequently, due to its shorter treatment course, superior efficacy, reduced side effects, and ease of use, Epclusa has been highly acclaimed in clinical practice.

However, the high price of Epclusa has deterred many patients. Director Wang Lei noted that although the drug demonstrates excellent efficacy, its use remains limited in the absence of medical insurance coverage or sufficient financial means. When recommending treatment regimens, physicians also take into comprehensive consideration the patient’s clinical condition and economic status.

Regarding whether Epclusa will be included in the national medical insurance coverage in the future, Director Wang Lei stated that its inclusion in the National Essential Medicines List this September signifies national recognition of the drug’s efficacy, safety, and clinical necessity. However, its formal inclusion in the medical insurance reimbursement list depends on various factors, such as the nation’s fiscal capacity and the outcome of price-reduction negotiations with the manufacturer. Nevertheless, given the severity of hepatitis C and the high curability offered by the treatment, Epclusa meets the fundamental criteria for inclusion in China’s national medical insurance drug list.

Director Wang Lei further stated that in the promotion of Epclusa, a highly effective medication, distribution should not be limited to hospital pharmacies. If the general public could purchase the drug at retail pharmacies while still benefiting from medical insurance coverage, it would greatly facilitate patient treatment. Moreover, with the rapid development of internet healthcare platforms such as YiLian, physicians can manage patients and issue electronic prescriptions on these platforms, which will save doctors’ time and energy to some extent and improve the efficiency of medical care for patients.

Furthermore, in February 2018, Gilead launched the “Striving for a Cure for Hepatitis C” initiative, supporting the China Primary Health Care Foundation in rolling out a patient assistance program that provides substantial medication cost reductions for hepatitis C patients in impoverished areas. Director Wang Lei regarded this move as highly meaningful, noting that the Second Hospital of Shandong University is also a participant in the assistance program, providing pharmaceutical and medical aid to indigent patients.

Regarding hepatitis C prevention, Director Wang Lei stated that the development of a hepatitis C vaccine is extremely challenging, with difficulties comparable to those associated with HIV/AIDS. This is primarily due to the high mutability of the hepatitis C virus (HCV) and the fact that protective neutralizing antibodies against HCV remain poorly understood. Therefore, preventing hepatitis C requires a clear understanding of its transmission routes. It is important to note that casual daily contact, such as sharing meals or breathing the same air, does not transmit hepatitis C. The primary mode of transmission is through blood, followed by exposure to bodily fluids. Risk factors include unsafe injection practices, needlestick injuries, sharing personal items such as toothbrushes and razors, undergoing tattooing or cosmetic procedures at unlicensed establishments, and receiving medical treatments such as intravenous infusions or tooth extractions at non-compliant clinics. Additionally, hepatitis C can be transmitted sexually and from mother to child.

In 2014, the Chinese government also issued relevant regulations requiring active screening for high-risk populations. Individuals who received blood transfusions or used blood products before 1995, people who inject drugs, patients undergoing dialysis or those with occupational blood exposure, and individuals who underwent cosmetic procedures such as eyebrow tattooing or ear piercing at unlicensed facilities should proactively undergo screening for hepatitis C virus (HCV) antibodies to ensure early detection and treatment. Hepatitis C is curable when treated properly at accredited medical institutions. Furthermore, curing hepatitis C effectively controls the source of infection at its origin.

In the prevention and control of hepatitis C, it is also essential to interrupt transmission routes. Over the past two decades, China has implemented voluntary blood donation, abolished professional blood donation, and conducted screening for hepatitis C, thereby virtually eliminating transmission through blood and blood products. In medical settings, strict adherence to the principles of “one patient, one use, one sterilization” and “one patient, one needle, one syringe” must continue to be emphasized. Regarding mother-to-child transmission, women should undergo hepatitis C antibody screening before pregnancy to prevent conception while carrying the virus. Finally, susceptible populations need to be protected, with the hope that a hepatitis C vaccine will be developed as soon as possible. At present, only by curing hepatitis C and interrupting its transmission routes can we achieve the ambitious vision of fully controlling hepatitis C by 2030.