[Hepatitis C: From Individual Cure to Worldwide Elimination?]

Area of Science:

• Hepatology
• Virology
• Infectious Diseases

Background:

• Direct-acting antivirals (DAAs) offer high cure rates for chronic hepatitis C virus (HCV) infection, achieving sustained viral response (SVR) in most patients.
• DAA therapy significantly reduces the risk of hepatocellular carcinoma (HCC) in non-cirrhotic patients.
• High rates of new HCV infections and undiagnosed cases hinder global elimination efforts.

Purpose of the Study:

• To assess the impact of DAAs on HCV elimination and HCC risk.
• To identify challenges and strategies for achieving the WHO's 2030 HCV elimination goal.
• To review the status of HCV vaccine development.

Main Methods:

• Review of DAA efficacy and outcomes in HCV patients.
• Analysis of HCV reinfection and new infection rates.
• Evaluation of barriers to HCV vaccine development and ongoing clinical trials.

Main Results:

• DAA therapy leads to SVR in the majority of patients, with reduced HCC risk in those without cirrhosis.
• Relapse and reinfection are key considerations in viremic patients post-DAA therapy.
• Generic DAAs show comparable cure rates to original drugs.
• HCV variability and immune evasion strategies pose challenges for vaccine development, with two candidates in clinical trials.

Conclusions:

• Achieving WHO HCV elimination goals requires robust strategies for identifying and treating all infected individuals.
• Despite effective therapies, a protective HCV vaccine is crucial for sustainable reduction of new infections globally.
• Addressing undiagnosed infections and high reinfection rates is critical for HCV eradication.