Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

Abstract

<jats:p>The treatment of chronic hepatitis C (CHC) has been revolutionized in an era of all-oral direct-acting antivirals (DAAs) since 2014. Satisfactory treatment efficacy and tolerability can be provided by novel DAAs. Nevertheless, there are still some unmet needs and emerging issues in the treatment of CHC in the DAA era. Certain hard-to-cure populations are prone to have inferior treatment responses, including patients with severe liver decompensation, active hepatocellular carcinoma (HCC), and hepatitis C virus (HCV) genotype 3 (HCV-3) infection and those who experience multiple DAA treatment failures. Hepatitis B virus (HBV) reactivation during and after DAA treatment has raised concern regarding the use of prophylactic antivirals against HBV throughout DAA treatment. However, the standard strategy for the use of prophylactic antivirals is not uniform across regional guidelines. In the post-sustained virological response (SVR) period, HCC still occurs in a substantial proportion of patients. Due to the relatively short follow-up period, the net benefit of the achievement of an SVR by DAAs in the reduction of extrahepatic manifestations has not yet been determined. Attention must also be paid to HCV reinfection, particularly in high-risk populations. The most critical and unmet need for HCV elimination is the large gap in the HCV care cascade at the population level. To accomplish the World Health Organization (WHO)’s goal for HCV elimination by 2030, the expansion of access to HCV care requires a continuous effort to overcome practical and political challenges.</jats:p>

Outcomes of Hepatitis C Virus Treatment with Ledipasvir/Sofosbuvir in Mongolian Population: Successes and Challenges Facing Scale-up of Care

“…11 In the era of DAAs, where treatment efficacy and tolerability are no longer the major concerns, a comprehensive HCV care cascade is needed, including proper screening for unawareness of HCV, accurate diagnosis, and linking to medical care. 12 Although the amount of clinical interest is low, the findings of this study conducted by the Mongolian government for Hepatitis Prevention, Control and Elimination are meaningful. Moreover, this large sized study showed the effectiveness of LDV/SOF at a fixed dose and treatment duration in helping to promote universal healthcare for CHC in countries with resource-limited settings.…”

Path from the discovery to the elimination of hepatitis C virus: Honoring the winners of the Nobel Prize in Physiology or Medicine 2020

“…In contrast, in patients with incurable HCC and life expectancy of >1 year, the HCV treatment should be initiated immediately (Figure 1). 19,21 In the meantime, three populations, including patients with cirrhosis and HCV genotype 3, patients with previous DAA failures, and patients with decompensated cirrhosis require special considerations with different recommended DAA regimens, as summarized in Table 1, based on the 2020 Taiwan Consensus on Hepatitis C Management.…”

Scaling up the in-hospital hepatitis C virus care cascade in Taiwan

“…Each of these steps is a critical hurdle that adds complexity, which prevents the healthcare system from eliminating HCV infection. [2,8,9] To accurately confirm ongoing HCV infection, laboratory testing typically begins with the detection of antibodies to HCV (anti-HCV), followed by the confirmation of the presence of HCV RNA in the blood of subjects who are anti-HCV seropositive.…”