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Hepatitis C virus elimination: So close, so far?

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Hepatitis C virus (HCV) is curable with direct-acting antivirals (DAAs), yet global elimination efforts lag due to persistent transmission and systemic barriers. Addressing these challenges requires integrated care and political commitment.

Keywords:
Direct-acting antiviralsGlobal healthHepatitis C virusPublic health strategiesViral elimination

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Area of Science:

  • Hepatology
  • Virology
  • Public Health

Background:

  • Direct-acting antivirals (DAAs) offer high cure rates (>95%) for hepatitis C virus (HCV) infection.
  • HCV elimination is a WHO goal, but global progress has been insufficient.

Purpose of the Study:

  • To review the molecular virology and DAA pharmacology enabling HCV cure.
  • To analyze factors hindering HCV elimination despite effective treatments.

Main Methods:

  • Summary of HCV molecular virology and DAA mechanisms.
  • Analysis of epidemiological and systemic barriers to HCV elimination.

Main Results:

  • DAAs provide high genetic barriers to resistance, ensuring definitive virological cure.
  • Persistent transmission in key populations, incomplete diagnosis, care cascade losses, reinfection, and lack of vaccine impede progress.
  • Stigma, criminalization, inequitable access, weak health systems, and inconsistent political will exacerbate challenges, especially in LMICs.

Conclusions:

  • HCV elimination requires sustained political will and equitable access to diagnostics and treatment.
  • Integrating care into primary/community services, harm reduction, and coordination are crucial.
  • Overcoming structural barriers is essential for population-level impact.