Abstract
Hepatitis C virus (HCV) infection, defined by active carriage of HCV RNA, affects nearly 1.0% of the worldwide population. The main risk factors include unsafe injection drug use and iatrogenic infections. Chronic HCV infection can promote liver damage, cirrhosis and hepatocellular carcinoma (HCC) in affected individuals. The advent of new second-generation, direct-acting antiviral (DAA) agents allow a virological cure in more than 90% of treated patients, and therefore prevent HCV-related complications. Recently, concerns have been raised regarding the safety of DAA-regimens in cirrhotic patients with respect to the occurrence and the recurrence of HCC. Here, we review the current available data on HCV epidemiology, the beneficial effects of therapy, and discuss the recent controversy with respect to the potential link with liver cancer. We also highlight the challenges that have to be overcome to achieve the ambitious World Health Organization objective of HCV eradication by 2030.
Highlights
The treatment of chronic hepatitis C virus (HCV) infection has undergone a recent revolution since the advent of new second-generation, direct-acting antiviral (DAA) agents with initial marketing authorization obtained in 2013 and 2014 in most Western countries
Among intravenous drug users (IVDU), the overall HCV seroprevalence was estimated at 52.3%
Patients treated with IFN-based therapy achieving sustained virological response (SVR) have been shown to have a significantly lower risk of developing hepatocellular carcinoma (HCC) than those who did not [55,56,57,58,59]
Summary
The treatment of chronic hepatitis C virus (HCV) infection has undergone a recent revolution since the advent of new second-generation, direct-acting antiviral (DAA) agents with initial marketing authorization obtained in 2013 and 2014 in most Western countries These new, very effective molecules left behind the triple therapy comprising an NS3/4A protease inhibitor that arrived in 2011 and the pegylated-interferon/ribavirin combination (PEG-IFN/RBV), a dual therapy that has been used for more than 15 years. These new treatments allow the long-term viral eradication and a virological cure in more than 90% of treated patients. In all Western countries, the decrease in costs associated with an increase in the number of molecules on the market will lead to the universal access to HCV treatment very soon, making it possible to cover all patient populations
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