The emergence of effective direct‐acting antiviral (DAA) agents has reignited discussion over the potential for hepatitis C elimination in the United States. Eliminating hepatitis C will require a critical examination of technical feasibility, economic considerations, and social/political attention. Tremendous advancement has been made with the availability of sensitive diagnostic tests and highly effective DAAs capable of achieving sustained viral response (SVR) in more than 95% of patients. Eliminating hepatitis C also requires escalating existing surveillance networks to monitor for new epidemics. All preventive interventions such as clean syringe and needle exchange programs, safe injection sites, opioid substitution therapies, and mental health services need to be expanded. Although costs of DAAs have raised budget concerns for hepatitis C elimination, studies have shown that eliminating hepatitis C will produce a savings of up to 6.5 billion USD annually along with other intangible benefits such as increased work productivity and quality of life. Economic models and meta‐analyses strongly suggest universal hepatitis C screening for all adults rather than just for birth cohort and high‐risk populations. Social and political factors are at least as important as technical feasibility and economic considerations. Due to lack of promotion and public awareness, HCV elimination efforts continue to receive inadequate funding. Social stigma continues to impede meaningful policy changes. Eliminating hepatitis C is an attainable public health goal that will require intense collaboration and sustained public support. (Hepatology 2018;67:2449‐2459).

中文翻译：

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在美国消除丙型肝炎

有效的直接作用抗病毒 (DAA) 药物的出现重新引发了关于在美国消除丙型肝炎的潜力的讨论。消除丙型肝炎需要对技术可行性、经济考虑和社会/政治关注进行严格审查。随着敏感诊断测试和高效 DAA 的出现，能够在超过 95% 的患者中实现持续病毒反应 (SVR)，从而取得了巨大的进步。消除丙型肝炎还需要升级现有的监测网络以监测新的流行病。需要扩大所有预防性干预措施，例如清洁注射器和针头更换计划、安全注射点、阿片类药物替代疗法和心理健康服务。尽管 DAA 的成本引起了消除丙型肝炎的预算问题，但研究表明，消除丙型肝炎每年将产生高达 65 亿美元的节省以及其他无形收益，例如提高工作效率和生活质量。经济模型和荟萃分析强烈建议对所有成年人进行普遍的丙型肝炎筛查，而不仅仅是对出生队列和高危人群进行筛查。社会和政治因素至少与技术可行性和经济考虑一样重要。由于缺乏宣传和公众意识，HCV 消除工作继续得不到足够的资金。社会污名继续阻碍有意义的政策变革。消除丙型肝炎是一个可以实现的公共卫生目标，需要密切合作和持续的公众支持。