[Chronic hepatitis C infection--eradication of the virus]

Hepatitis C virus (HCV) infection, a worldwide public health problem affecting 180 million patients, is Likely the cause of chronic hepatitis, liver cirrhosis, liver failure, and hepatocellular carcinoma. In Israel it is estimated that 100,000 people are infected with HCV, 25% are diagnosed and 20-22% were treated with antiviral agents. Advances in our understanding of the HCV lifecycle have led to development of direct acting antiviral agents (DAAs) therapies capable of increasing significantly the curative SVR rates in patients with HCV. New standard-of-care treatment has been approved in 2011 for HCV genotype 1 that has markedly improved treatment results, based on a triple combination of pegylated IFN-alpha, ribavirin, and either telaprevir or boceprevir, two inhibitors of the HCV protease. Two new oral antiviral agents, simeprevir and sofosbuvir, have already been approved and are now available. Other antiviral agents will be available during 2014-2015 and many others, are in phase II or III clinical development. The results of nine phase-3 interferon-free combination regimens of DAAs were reported in the NEJM 2014. These studies demonstrated unequivocal superiority of such regimens over the standard-of-care treatment with an SVR rate of > or = 90% in HCV genotype 1 and 2, naïve, experienced and cirrhotics patients. Interferon-free regimens are associated with lower rate and severity of side effects and a shorter duration of treatment. A number of unanswered questions remain treating special populations, the role of ribavirin, genotype 3, the role of HCV resistance, and how to re-treat failures of treatment. The Ministry of Health wills have to consider: 1. HCV screening in high risk populations. 2. The strategic choices based on cost issues (the predicted costs of the new oral DAAs is extremely high) and on the severity of the liver disease.