Countermeasures against viral hepatitis in Japan: road to HCV elimination

ABSTRACT

The World Health Organization (WHO) has set a goal of elimination of viral hepatitis by 2030. In Japan, the estimated people of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections were 1.7-2.2 and 1.3-1.5 million in 2000, respectively. Although the mortality due to hepatocellular carcinoma (HCC) had been increasing until around 2002, it has been gradually decreasing to date, and approximately 24,000 people died from HCC in 2021 in Japan. Japan has a national action plan for addressing viral hepatitis called, ''Basic Act on Hepatitis Measures'', established in 2009. ''Basic Guidelines for Promotion of Control Measures for Hepatitis'' was issued in 2011 and was updated in 2016 and 2022, comprising 9 principles in order to promote measures to prevent HBV and HCV. According to these guidelines, national and local government share screening costs for testing HBV and HCV for those residents who are over 40 years old. Thus, out-of-pocket expenses from examinees are free of charge or reduced to a minimum. In addition, for patients with chronic HBV or HCV infections treated with nucleotide analogues, interferon, and direct antiviral agents, the drug prices and examination expenses were covered by a medical-expenses support system for viral hepatitis. By these countermeasures against viral hepatitis, the estimated people of chronic HCV infection revealed a decrease to 1.0-1.6 million in 2011 (30-40% decrease from 2000 level) and 0.9-1.3 million in 2015 (40- 50% decrease from 2000 level). If the current situation had been continuing, the number of HCV patients is expected to decrease to 0.2-0.5 million (80-90% decrease from 2000 level and 60-80% decrease from 2015 level) by 2030. However, the COVID-19 pandemic since December 2019 is thought to have affected testing, linkage to care, treatment uptake, and follow-up, and new efforts that do not slow the progress to date toward HCV elimination, which is finally becoming visible, will be necessary in the future. In this lecture, I would also like to talk about the efforts at our hospital to achieve the sustainable development goal targeted by WHO.