How Internet Healthcare Enhances Convenience for Hepatitis C Patients: Insights from a Leading Physician
Director Chen Guofeng, Fifth Medical Center of the Chinese PLA General Hospital (formerly the 302 Hospital)
Like the third-place finisher in a competition, hepatitis C once lacked its own specific name and was long referred to as non-A, non-B hepatitis virus. It was not until 1989, when researchers successfully isolated it using novel molecular biotechnology, that it received its official designation. To this day, public awareness of hepatitis C remains incomparable to that of hepatitis B.
Most patients infected with the hepatitis C virus (HCV) exhibit no obvious symptoms. By the time the infection is detected, often ten to several decades later, the disease may have already progressed to liver cirrhosis or even hepatocellular carcinoma. Consequently, hepatitis C is referred to in the medical community as the "invisible killer" and is the second leading infectious cause of cancer-related mortality after hepatitis B.
According to statistics from the World Health Organization (WHO), approximately 180 million people worldwide are infected with the hepatitis C virus (HCV), with 35,000 new cases reported annually. In reality, due to insufficient public awareness of hepatitis C and a high rate of missed diagnoses, nearly 80% of patients are unaware that they have contracted hepatitis C, a situation that is even more severe than it appears.
Chen Guofeng, Director of the Second Department of Liver Cirrhosis at the Fifth Medical Center of the Chinese PLA General Hospital (formerly the 302 Hospital), stated, “Generally, sudden diseases that spread globally and cause significant harm, particularly infectious diseases, are regarded as global public health issues. Given the current number of hepatitis C patients, hepatitis C certainly qualifies as a global public health issue. The prevention and control of such issues warrant sufficient attention from global organizations and governments worldwide. For instance, the World Health Organization (WHO) has set a goal to eliminate hepatitis C by 2030, and China updated its guidelines for the prevention and treatment of hepatitis C in 2015. Although significant progress has been made, efforts must be intensified to screen high-risk populations, striving to ensure no cases are missed.”
“Similar to hepatitis B, hepatitis C is primarily transmitted through blood, sexual contact, and mother-to-child transmission. Due to low public awareness of hepatitis C, its detection is often incidental. Patients are frequently diagnosed during evaluations for gum bleeding, preoperative screenings, blood donation tests, or prenatal check-ups. Given the modes of transmission, high-risk groups—including people who inject drugs, sex workers, and individuals living with HIV—are advised to proactively undergo hepatitis C screening. Members of the general population who have been exposed to potential transmission routes should also seek timely medical evaluation. Examples include undergoing dental scaling, eyebrow tattooing, or acupuncture at clinics with inadequate sterilization protocols, as well as having multiple sexual partners or engaging in unprotected sexual activity.” Dr. Chen Guofeng further stated, “In the current social landscape, various medical aesthetic procedures are widely popular but may carry risks. Although national regulation of such institutions has become increasingly stringent, some facilities may still fail to strictly adhere to operational standards due to cost considerations. For instance, they might reuse non-disposable syringes and needles or use inadequately sterilized instruments for needle-based or invasive procedures.”
Director Chen Guofeng believes that a very clear goal of hepatitis C science popularization is to achieve 100% screening among high-risk populations. When necessary, hepatitis C testing should be incorporated into annual corporate health checkup packages. This approach not only helps patients with hepatitis C achieve early detection and timely treatment but also enables the protection of patients’ family members and children through informed awareness. However, given the general public’s incomplete understanding of hepatitis C, implementing universal screening requires enterprises to ensure robust privacy protection for their employees.
Director Chen Guofeng stated, “After hepatitis C virus infection, due to individual differences, 15%–35% of individuals can spontaneously clear the virus and achieve self-cure. However, the majority of patients will progress to chronic infection. It is recommended that individuals who have been exposed to high-risk transmission routes promptly visit a hospital for targeted screening.”
Similar to HIV, antibody production does not occur immediately after hepatitis C virus (HCV) infection. It takes 4–24 weeks for anti-HCV (hepatitis C virus antibodies) to become detectable in serum. HCV RNA (hepatitis C virus ribonucleic acid) appears earlier but still requires approximately two weeks to be detected. This means that testing should be conducted two to four weeks after high-risk exposure. If blood is donated during the “window period,” both anti-HCV and HCV RNA may be undetectable, leading to missed diagnoses, delayed treatment, and potential transmission of the hepatitis C virus.
What is the current status of diagnosis and treatment for hepatitis C?
Viral infections trigger antibody production in the body; however, antibodies against the hepatitis C virus (HCV) cannot neutralize or eliminate the virus, nor do they provide protective immunity. Nevertheless, antibody testing remains the primary initial diagnostic approach for hepatitis C. A negative result indicates that treatment is unnecessary. A positive result suggests either current or past HCV infection. Therefore, anti-HCV testing is generally used as a screening test for hepatitis C.
To further assess the viral status, HCV-RNA testing is required. If the result is negative, treatment is not necessary; if positive, appropriate treatment should be initiated regardless of transaminase levels. In contrast, the diagnosis of hepatitis B differs: if hepatitis B virus markers are positive but transaminase levels are normal, the patient may be an asymptomatic carrier and does not require treatment.
The hepatitis C virus (HCV) mutates rapidly and has numerous subtypes. Due to this characteristic, no HCV vaccine has been developed to date, making it impossible to prevent infection through vaccination as is done for hepatitis B.
Regarding specific treatment approaches, Director Chen Guofeng informed us that the treatment of hepatitis C has undergone a lengthy evolution. Early treatment for hepatitis C primarily relied on interferon monotherapy. Interferon is a cytokine produced by lymphocytes in the human immune system in response to viral stimulation. It works by enhancing the body’s immune function to interfere with viral replication, rather than directly killing or inhibiting the virus. Consequently, cure rates were low, and side effects were significant. Currently, three types of interferons are commonly used in clinical practice: pegylated interferon alfa-2a, pegylated interferon alfa-2b, and standard interferon. The first two are long-acting interferons administered via injection once weekly, while the latter is a short-acting interferon requiring injection every other day.
The combination of ribavirin and interferon significantly improved the cure rate for hepatitis C. It can be said that prior to 2013, the combination of interferon and ribavirin remained the primary treatment modality for hepatitis C. However, due to their limited specificity against the hepatitis C virus (HCV), the therapeutic efficacy of this combination was suboptimal. The severe side effects associated with this regimen led many patients to forego treatment. A 2011 study in China involving 997 patients with hepatitis C demonstrated that over 50% of HCV-infected individuals were either unsuitable candidates for or unable to tolerate interferon combined with ribavirin therapy.
Certainly, pharmaceutical researchers have been continuously developing more effective antiviral drugs. In 2011, the first generation of direct-acting antiviral agents (DAAs) was introduced, significantly improving the viral clearance rate for hepatitis C. In 2013, the advent of sofosbuvir brought new hope to patients with hepatitis C. By inhibiting the NS5B protein of the hepatitis C virus, it completely disrupts the processes of viral replication and assembly, achieving a cure rate of 95%. Sofosbuvir is effective against all six genotypes of chronic hepatitis C, thereby covering the broadest patient population.
However, sofosbuvir does not solve all problems. The non-structural proteins of the hepatitis C virus (HCV) are major components in viral replication. In addition to the NS5B protein, there are several other key proteins, such as NS5A and NS3/4A. This makes it impossible to cure patients with sofosbuvir monotherapy, which still requires combination with interferon or other direct-acting antiviral (DAA) drugs. After 2014, interferon was no longer needed for HCV treatment, achieving the goal of curing hepatitis C with all-oral DAA regimens. Gilead subsequently developed combination formulations capable of simultaneously inhibiting the NS5A protein, namely Harvoni (commonly known as “Gilead’s second generation”) and Epclusa (“Gilead’s third generation”), as well as Vosevi (“Gilead’s fourth generation”), which received U.S. FDA approval in 2017.
As the first pan-genotypic hepatitis C treatment, Epclusa was approved by the National Medical Products Administration on May 23, 2018, for the treatment of adult patients with chronic hepatitis C virus (HCV) infection of genotypes 1–6.
In this regard, Director Chen Guofeng stated that the pan-genotypic antiviral efficacy of Epclusa is widely recognized. In clinical practice, frequent monitoring is not required, which reduces costs for patients and saves time for both patients and physicians. However, for specific genotypes, multiple direct-acting antiviral (DAA) regimens are available, and Epclusa should be considered one of the optimal treatment options. There remains significant room for improvement in hepatitis C treatment in the future. Meanwhile, the successful development of a hepatitis C vaccine cannot be ruled out.
Discussing the value of internet healthcare within the overall medical system, Director Chen Guofeng believes that its benefits are highly evident, particularly in patient management, electronic prescription issuance, and medication delivery. Currently, Medlinker has established a strategic partnership with Gilead Sciences to create a closed-loop online-to-offline healthcare model for hepatitis C, a single-disease focus, thereby providing tangible convenience for patients seeking medical care.
Director Chen Guofeng informed us that most patients can be cured with a single course of Epclusa. Compared to the traditional combination therapy of ribavirin and interferon, Epclusa not only has a shorter treatment duration but also offers higher safety and fewer side effects.
Nevertheless, given the varying financial circumstances of hepatitis C patients, inclusion in the national medical insurance scheme remains an urgent demand for the majority of them. Tasked with the mission of “driving down prices” for the benefit of the public, the national healthcare security authorities, shortly after their establishment, successfully negotiated the inclusion of 17 anti-cancer drugs into the National Reimbursement Drug List, achieving an average price reduction of 56.7%, with the highest reduction reaching 71%. For most imported drugs, the post-negotiation reimbursement standards are lower than the market prices in neighboring countries or regions, averaging 36% lower.
China, with its massive population, has the largest number of hepatitis C patients worldwide. The inclusion of Epclusa in China’s national medical insurance scheme would unlock a significantly larger market. Data shows that curing hepatitis C boosted national productivity by as much as €2.7 billion across five European countries (Italy, France, Spain, Germany, and the United Kingdom). For China, adding Epclusa to the national medical insurance list means easier access to cure for a growing number of hepatitis C patients, thereby enhancing national productivity.