Road to elimination of HCV: Clinical challenges in HCV management

Abstract

In 2020, the Nobel Prize in Medicine was award to Harvey J. Alter, Michael Houghton and Charles M. Rice for their work on the discovery of hepatitis C virus (HCV). The race to identify and screen the 'non-A, non-B' virus contaminating the blood supply was a transformative technical breakthrough that resulted in not only a safer blood supply but also in major advances in virology, immunology, diagnostic testing and liver pathology. 1 At the National Institutes of Health, Harvey J. Alter showed that hepatitis cases associated with

Modeling-Based Response-Guided DAA Therapy for Chronic Hepatitis C to Identify Individuals for Shortening Treatment Duration

“…The advent of all-oral direct-acting antivirals (DAAs) has transformed the landscape of hepatitis C virus (HCV) therapy and paved the path to the ambitious World Health Organization goal of viral hepatitis elimination by 2030 [ 1 ]. However, several remaining challenges such as DAA cost and treatment of HCV in special populations must be overcome to achieve this goal [ 2 , 3 ]. Shortening duration of DAA therapy could provide cost savings [ 4–7 ], reduce medication exposure (eg, during pregnancy [ 8 ]), and help to foster adherence and treatment completion in general [ 9 ] and specifically in special populations (eg, people who inject drugs [ 2 ] and incarcerated individuals [ 10 ]), which is key to achieving cure [ 11 ].…”

“…However, several remaining challenges such as DAA cost and treatment of HCV in special populations must be overcome to achieve this goal [ 2 , 3 ]. Shortening duration of DAA therapy could provide cost savings [ 4–7 ], reduce medication exposure (eg, during pregnancy [ 8 ]), and help to foster adherence and treatment completion in general [ 9 ] and specifically in special populations (eg, people who inject drugs [ 2 ] and incarcerated individuals [ 10 ]), which is key to achieving cure [ 11 ]. Thus, identifying individuals for shortening DAA therapy duration is warranted.…”

The changing epidemiology of liver diseases in Asia

“…(2) only a small proportion of HCV patients have been diagnosed and treated; (3) patients remain at increased risk of HCC even after the elimination of HCV, especially in they are treated at the cirrhotic stage. 3…”

“…Although we have safe and effective combination therapies with direct antiviral agents (DAA) against multiple HCV genotypes and nearly all patients can be successfully treated, clinical challenges remain on the road to HCV elimination. These include: (1) there is a subset of patients who still do not respond to available therapies and harbor mutations against which few current DAAs are effective; (2) only a small proportion of HCV patients have been diagnosed and treated; (3) patients remain at increased risk of HCC even after the elimination of HCV, especially in they are treated at the cirrhotic stage 3 …”

Mathematical modeling of plus-strand RNA virus replication to identify broad-spectrum antiviral treatment strategies

“…Treatment options are limited for the majority of plus-strand RNA viruses. While there are vaccines and vaccine candidates available for few viruses, approved direct acting antivirals are only available against hepatitis C and SARS-CoV-2 [8,9]. Given the high disease burden and socio-economic cost caused by infections with plus-strand RNA viruses, there is an urgent need for broadly acting antiviral drugs.…”