Global elimination of hepatitis C virus infection: Progresses and the remaining challenges

Abstract

Today, with the introduction of interferon-free direct-acting antivirals and outstanding progresses in the prevention, diagnosis and treatment of hepatitis C virus (HCV) infection, the elimination of HCV infection seems more achievable. A further challenge is continued transmission of HCV infection in high-risk population specially injecting drug users (IDUs) as the major reservoir of HCV infection. Considering the fact that most of these infections remain undiagnosed, unidentified HCV-infected IDUs are potential sources for the rapid spread of HCV in the community. The continuous increase in the number of IDUs along with the rising prevalence of HCV infection among young IDUs is harbinger of a forthcoming public health dilemma, presenting a serious challenge to control transmission of HCV infection. Even the changes in HCV genotype distribution attributed to injecting drug use confirm this issue. These circumstances create a strong demand for timely diagnosis and proper treatment of HCV-infected patients through risk-based screening to mitigate the risk of HCV transmission in the IDUs community and, consequently, in the society. Meanwhile, raising general awareness of HCV infection, diagnosis and treatment through public education should be the core activity of any harm reduction intervention, as the root cause of failure in control of HCV infection has been lack of awareness among young drug takers. In addition, effective prevention, comprehensive screening programs with a specific focus on high-risk population, accessibility to the new anti-HCV treatment regimens and public education should be considered as the top priorities of any health policy decision to eliminate HCV infection.

Prevalence of Hepatitis C virus genotypes in nine selected European countries: A systematic review

“…Thus, it is clear that in this context, pathogenicity and the duration and cost of treatment are still influenced by different HCV genotypes. 47,[49][50][51] According to our results, G1 is the predominant genotype accounting for 61.2% (95% CI; 53.6-68.7) of all anti-HCV infections among adults, ranging from 80.0% in Croatia to 46.0% in Greece.…”

“…Although the introduction of DAAs has solved most of adverse effects of IFN‐based therapy, increasing the rates of SVR the high costs and restricted accessibility of DAA drugs are still the main drivers in the treatment decisions, especially in low‐ and middle‐income countries. Thus, it is clear that in this context, pathogenicity and the duration and cost of treatment are still influenced by different HCV genotypes …”

Hepatite C

“…O VHC tem como estrutura genômica o RNA, e codifica uma poliproteína com aproximadamente três mil aminoácidos, que dá origem a proteína do capsídeo (C), duas proteínas do envelope (E1 e E2) e a outras proteínas não estruturais (NS1, NS2, NS3, NS4A, NS4B, NS5A e NS5B). Apresenta aproximadamente 11 genótipos e por volta de 80 subtipos, e, diante dessa variabilidade genômica atrelada a alta taxa de mutação viral a população infectada pelo vírus é extremamente heterogênea, o que facilita a sobrevivência viral perante os ataques do sistema imune do hospedeiro 3,[12][13][14][15] .…”

“…Entre as hepatites virais, encontra-se a hepatite C que em função da sua gravidade, é hoje a causa mais comum de indicação para transplante hepático. Trata-se de uma doença com evolução lenta, mas com alta taxa de cronicidade tornando-a potencialmente fatal, em comparação com os diferentes tipos de hepatites virais [1][2][3] .…”

Sustained virologic response rates in patients with chronic hepatitis C genotype 6 treated with ledipasvir+sofosbuvir or sofosbuvir+velpatasvir

“…Of those infected with HCV, 15%‐30% are at risk of developing cirrhosis within 20 years . Chronic HCV infection is also associated with liver failure, hepatocellular carcinoma (HCC), liver transplantation, and death . HCV‐related disease burden continues to grow, causing a substantial public health and economic burden on countries where HCV is prevalent …”