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Why highly effective drugs are not enough: the need for an affordable solution to eliminating HCV
C Nelson Hayes1,2, Kazuaki Chayama1,2,3
1a Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences , Hiroshima University , Hiroshima , Japan.
Insights
Direct-acting antiviral drugs offer a cure for hepatitis C virus (HCV) infection, but challenges remain. Addressing cost, accessibility, and resistance is crucial for HCV eradication.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Chronic hepatitis C virus (HCV) infection is increasingly curable due to direct-acting antiviral (DAA) drug development.
- Current DAA therapies achieve high cure rates (>90%) but overlook critical issues.
- Key challenges include drug cost, global availability, and the emergence of antiviral resistance.
Purpose of the Study:
- To provide an overview of current HCV therapies and DAA development.
- To discuss the limitations and challenges associated with DAA therapy.
- To propose future strategies for HCV management and drug development.
Main Methods:
- Literature search for relevant studies on HCV therapies and DAAs.
- Web search for news articles and press releases on HCV drug development and policy.
- Expert commentary synthesizing current knowledge and future directions.
Main Results:
- DAA therapies demonstrate high efficacy in treating HCV infection.
- Significant barriers to widespread HCV treatment include high costs and limited accessibility.
- Antiviral resistance poses a growing concern, necessitating proactive management strategies.
Conclusions:
- Despite high cure rates, declaring victory against HCV is premature.
- Future efforts must prioritize addressing cost, availability, and resistance to achieve HCV eradication.
- Developing host-targeting antivirals and a universal HCV vaccine are key long-term goals.
- Large-scale screening in endemic areas is essential for early detection and treatment to prevent advanced liver disease.
Introduction:
Because of the rapid pace of development of new direct-acting antiviral (DAA) drugs, chronic hepatitis C virus (HCV) infection is now increasingly considered curable. However, the emphasis on DAA therapies disregards key issues related to cost, availability, and antiviral resistance. Areas covered: This perspective provides an overview of current HCV therapies and the development of DAAs, followed by a discussion of the limitations of DAA therapy. A literature search was used to select relevant studies, and a web search for relevant news articles and press releases was conducted. Expert commentary: Despite cure rates exceeding 90%, now is not the time to declare victory against HCV but to reinforce recent progress by addressing the issues of cost and availability as well as by developing strategies to manage antiviral resistance. Future drug development efforts should place greater emphasis on targeting host factors required for HCV replication, for which the barrier to resistance is higher, and effort should continue to develop a vaccine against HCV. Finally, efforts should be made to facilitate large-scale screening in endemic areas to identify and treat patients as early as possible to reduce long-term risks of advanced liver disease and their attendant costs of management.