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A new World Health Organization (WHO) report chops the estimated number of people around the world living with the liver-damaging hepatitis C virus (HCV) in half—but the drop has nothing to do with the recent advent of powerful drugs that cure the disease for most everyone.
WHO’s Global Hepatitis Report estimates that 71 million people in 2015 were living with HCV, down from an earlier estimate of 130 million to 150 million. As the report explains, the dramatic drop occurred primarily because of tests that measured HCV’s genetic material, RNA, in people. Previous epidemiological surveys tested whether people had antibodies against the virus, which is less precise.
The report estimates that 257 million people are infected with hepatitis B virus (HBV), a number very close to previous estimates. Although HBV and HCV are unrelated, they both persist for decades, often without a person’s knowledge, and both can ultimately cause cirrhosis or liver cancer. Together, the viruses killed 1.34 million people in 2015, which the report notes is comparable to deaths from tuberculosis and higher than those from HIV/AIDS.
The previous focus on HCV antibodies, or “seroprevalence,” to determine the number of infected people is confusing in two ways, says Graham Cooke, a hepatitis specialist at Imperial College London. Cooke recently conducted a meta-analysis of studies in sub-Saharan Africa and found that only 51% of people deemed positive on antibody tests had evidence of viral RNA. As much as one-third of this discrepancy is because some people spontaneously clear the virus, he says, although the antibodies linger. Another factor is the antibody test itself, which Cooke says often was imprecise in the past.
The new focus on virus rather than antibody meshes with the global push to cure people with the new generation of drugs. Declaring someone cured requires demonstrating that the virus is undetectable on standard blood tests for 12 weeks after treatment stops. “We’re at a moment where we’re pivoting from describing to doing,” Cooke says. “When you’re describing you do seroprevalance. But you don’t need to cure everyone who has antibody.”