Liver Lineup: Progress, Policy, and Barriers in Hepatitis C Elimination

In this episode of Liver Lineup: Updates & Unfiltered Insights, hosts Kimberly Brown, MD, a professor of Medicine at Michigan State University and Wayne State University, associate medical director of the Henry Ford Hospital Transplant Institute, and medical director of Transplant Outreach Services at Henry Ford Hospital, and Nancy Reau, MD, a professor of internal medicine, the Richard B. Capps Chair of Hepatology, associate director of solid organ transplantation, and the section chief of hepatology at Rush University Medical Center, discuss the progress and persistent challenges in eliminating hepatitis C (HCV).

With highly effective, short-course oral therapies now available, Brown and Reau emphasize that curing HCV is more achievable than ever. The discussion explores the major policy, clinical, and structural milestones enabling this effort—and the critical gaps in diagnosis, treatment access, and health policy that still impede progress.

Reau opens by emphasizing the revolutionary nature of curative HCV therapies, which not only improve individual health outcomes but also reduce transmission, presenting a rare opportunity for public health impact on a global scale. She and Brown discuss how national and international efforts, including World Health Organization goals and US legislation, have aligned to prioritize viral hepatitis elimination.

Specifically, the hosts discuss the role of the US Preventive Services Task Force and the Affordable Care Act in establishing HCV screening as a covered preventive service. Outlining the evolution from birth cohort screening to universal screening for adults 18 and over, Reau and Brown discuss a recent legal challenge to the Affordable Care Act’s preventive service mandate that threatened access to HCV screening. The Supreme Court’s 6–3 decision to uphold this provision was, in their view, a critical win for public health and HCV elimination.

Despite these advances, both experts acknowledge major challenges remain in the HCV care cascade. Many patients are lost between screening and cure, often due to provider restrictions, system fragmentation, and lack of prioritization. They emphasize the need for government-backed elimination efforts, drawing lessons from successful national programs in countries like Egypt and Georgia.

The conversation also underscores the role of grassroots advocacy, emphasizing the critical role clinicians and patients alike can play in supporting federal hepatitis elimination legislation. Most importantly, they encourage patients to share their stories with legislators—a strategy proven effective in other public health movements, including HIV.

Reau additionally calls upon listeners to write to their local senators to support bipartisan legislation from senators Bill Cassidy (R-LA) and Chris Van Hollen (D-MD) to eliminate hepatitis C using the following link: Ask Senators to Cosponsor the Cure Hepatitis C Act

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.