Successes and challenges on the road to cure Hepatitis C

Hepatitis C virus (HCV) represents a significant health burden worldwide, with an estimated 185 million people chronically infected. A leading cause of liver transplantation, HCV infection can result in severe liver disease including cirrhosis and hepatocellular carcinoma. Cure of HCV infection results in substantial decreases in such liver-related morbidity and mortality. Prior therapies for HCV offered only 40% cure for the most difficult-to-treat genotype-1 infection, required 48 weeks of therapy with an injectable interferon, and included significant adverse events. The past year has seen the approval of five interferon-free directacting antiviral (DAA) regimens for HCV, including combinations of DAAs and fixed-dose combination pills. Sustained virologic response (SVR), the virologic surrogate for clinical cure, has improved to >90% for most populations across all HCV genotypes. While the successes attributable to DAA combination therapies will be many, there also remain challenges and much for us to learn as we embark on this journey to eradicate HCV. Here, we will discuss several of the greatest successes and future challenges in HCV therapeutics today.

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