Treatment of Hepatitis C: A New Paradigm toward Viral Eradication

Abstract

This unprecedented efficacy has led to speculation that HCV infection might be eradicated even in the absence of a vaccine, but there are many impediments to global eradication including ascertainment of silent carriers, access to medication, and high drug cost". -Harvey J. Alter 1 .

Seroprevalence of Hepatitis C in Children Without Identifiable Risk‐Factors

“…Although HCV prevalence is significantly lower in children when compared to adults, it is still considerable. A number of analyses have shown that HCV prevalence has been declining in many countries over the recent years mainly due to reduction of new infections post-implementation of blood supply screening and high-risk behaviors reduction in the post-HIV era (3); however, there have been few recent reports from the USA indicating an alarming increase associated with the opioid epidemic and an increase in PWID in 12–29 years old adolescents and young adults (14). CDC has recommended, for few years, active surveillance for HCV in adults born between 1945 and 1965 and most recently proposed to expand for all pregnant women and adults older than 18 years old residing in areas with an HCV prevalence >0.1% (75).…”

“…Recent data indicate that treatment of children >12 years with DAAs may be cost-effective and most recently such regimens have been approved for children older than 3 years old. Thus, expanding screening to include children may be debated (14).…”

“…These high‐risk behaviors can more frequently be expressed during adolescence (77); however, not treated infected adolescents can transmit HCV through high‐risk behaviors and this may impede HCV elimination. The new oral drugs are very effective in children achieving better sustained viral response independently of the genotype of HCV and they have less adverse side effects than treatment with interferon (14). Furthermore, considering cost‐effectiveness, since children need weight‐based doses, the treatment in children costs less.…”

“…Moreover, the treatment of children as young as 12 years is expected to be very cost‐effective with currently approved DAA regimens (13). Recently, DAA treatment has been approved for children older than 3 years old both in the United States and Europe (14). Treatment of HCV‐infected children is important since early in life eradication of HCV is crucial before high‐risk adolescent behaviors contribute to spreading the infection.…”

The Inside-Out of End-Stage Liver Disease: Hepatocytes are the Keystone

“…3 Importantly, new classes of direct-acting antiviral therapies targeting hepatitis C virus (HCV) protein products have demonstrated real-world cure rates exceeding 95%. 6 As a result, the contribution of HCV to the burden of cirrhosis and end-stage liver disease (ESLD) is decreasing. As an example, in 2018, HCV was the primary diagnosis for 10.4% of liver transplant recipients in the U.S., compared with 24% in 2014.…”