[Chronic hepatitis C: standard of care and perspective]

Chronic hepatitis C (HCV) is a major health problem with more than 150 million people infected worldwide. It is the leading cause of cirrhosis, hepatocellular carcinoma and liver transplantation in western countries. Nowadays the disease is curable in most patients as the development of directly acting antivirals against HCV allows between 90 and 95% of patients who receive treatment to achieve viral eradication. This innovation has been made possible by the understanding of the HCV life cycle as well as the development of in vitro models of HCV replication, that have led to the discovery of 3 key steps in the HCV life cycle that can be targeted to halt viral replication. Drugs targeting the NS3 Protease, the NS5A protein as well as the NS5B polymerase are now commercially available in Europe. By combining these drugs for 12 or 24 weeks, most HCV-positive patients can be cured of their infection. Still the treatment cascade requires at the moment expert management, due to the relative complexity and need for individualization of the current regimens, as well as the need for monitoring for side effects during treatment. This, together with low diagnostic rates in the general population and high pricing of directly acting antivirals is a major hurdle to universal treatment of HCV and emphasizes the need for simplier pangenotypic, ribavirin free anti-HCV regimens that are now in advanced phase of development and should enter the field in the next 12-18 months.