[Hepatitis C facing the challenge of healing]

Hepatitis C facing the challenge of healing. Hepatitis C virus (HCV) infection affects 71 million people worldwide. It is a systemic disease associating hepatic manifestations, extra-hepatic manifestations by cryoglobulinemic vasculitis and general manifestations related to chronic inflammation (diabetes, cardio-, reno- or cerebrovascular manifestations and extrahepatic cancers including non-Hodgkin's lymphoma). The significant morbidity and mortality related to HCV therefore justifies its screening, access to treatments that have significantly increased over the past two decades. Understanding the replicative cycle of HCV allowed indeed the development of HCV-specific direct antivirals targeting viral proteins (NS3/4A protease, NS5B polymerase with nucleos(t)idic inhibitors, NS5A multifunctional replication complex protein). The combination of two to three specific inhibitors, sometimes coformulated in a single tablet regimen, without pegylated interferon and most often without ribavirin, allows a high antiviral efficacy (more than 95% cure) for treatment durations of 8 to 12 weeks with a satisfactory tolerance. HCV infection is the only chronic infection that can be cured and hepatic or extrahepatic manifestations are mostly reversible. It underscores the importance of strengthening screening and access to care policies to hope for the elimination of viral C infection in the short term.