Towards HCV extinction with modern HCV treatment? “Yes we can !”

Abstract

With the availability of new drugs (Directly Acting Antivirals, DAA), the ambition to eradicate HCV infection even in patients infected by “difficult-to-treat” genotypes is becoming a reality. Benefits are enormous from an individual and a global perspective since about 3% people in the world are chronically infected, with a burden of 350,000 deaths related to the long-term complications of the disease (cirrhosis and hepato-cellular carcinoma). The lessons we learned from HIV treatment (Highly Active Antiretroviral Therapy, HAART) are that antivirals pay-off by saving costs of clinical complications, patients’ stress and sufferance, and an increase in productivity of the infected individuals can be achieved for the sake of the society. Moreover, control of HIV replication induced by HAART can reduce the infection burden in the general population by decreasing HIV transmissibility [1]. This is extremely important for infection control when coupled with behavioural interventions since for HIV (as for HCV) an effective vaccine is not yet available. So, with highly active anti-HCV treatments we can now follow in HAART’s footsteps and even get ahead of HAART costeffectiveness because HCV is eradicable and treatment can be stopped; by contrast, HAART must be continued lifelong with a consequent incremental cost. However, the road is still long and we should overcome several obstacles along the way. First, benefits of HCV treatment are maximal if treatment is prescribed, ideally, to all patients in need. Unfortunately, HCV epidemic is largely underground as most HCV infected individuals are