What You Need to Know About Hepatitis C Treatment Advances This Year

Summary and Overview

Hepatitis C is a viral liver infection that can cause chronic disease if untreated. Traditional interferon-based treatments were lengthy and had severe side effects. The introduction of direct-acting antivirals (DAAs) has transformed management, providing shorter, well-tolerated oral therapies with cure rates over 95%. Pangenotypic DAAs like glecaprevir/pibrentasvir (Mavyret®) are now approved for adults and children aged three and older, simplifying treatment across diverse populations, including those with HIV coinfection. However, risks such as hepatitis B reactivation require monitoring.

Despite medical advances, barriers like high drug costs, insurance restrictions, limited infrastructure, and stigma limit global access. Low- and middle-income countries face particular challenges, though successful national programs show progress is possible. Expanding access through primary care and reducing systemic obstacles is key to reducing hepatitis C morbidity and mortality worldwide.

Historical and Current Treatment Approaches

Before DAAs, hepatitis C treatment relied on interferon and ribavirin, involving long regimens with modest cure rates (~40-50%) and significant toxicity. Early protease inhibitor-based DAAs improved outcomes but were complex and still burdensome. Interferon-based therapies persist in some contexts but with limited applicability.

DAAs target essential HCV proteins, enabling shorter, all-oral regimens with fewer side effects and SVR rates exceeding 95%. Glecaprevir/pibrentasvir (Mavyret®) is effective in adults and children over three, with treatment durations from 8 to 16 weeks. Pediatric formulations and dosing adjustments support safety in younger patients. DAAs are also well tolerated in coinfected patients and support simplified treatment algorithms including minimal monitoring.

Clinical Trials and Research

Key trials include the Phase 3 M20-350 study showing efficacy of an eight-week Mavyret regimen in acute HCV, and a global Phase 4 trial supporting minimal monitoring during DAA therapy with maintained high SVR rates. The MAGELLAN-3 trial explored retreatment options for patients failing prior DAA therapy, informing guidelines recommending resistance testing and tailored extended regimens.

DAAs generally demonstrate high safety and adherence, with no major renal impacts when combined with other antivirals. However, comparative effectiveness studies between first-line DAA regimens are lacking, and retreatment strategies for some resistant cases remain limited. Ongoing research aims to address resistance, improve diagnosis, and enhance global care linkage.

Impact on Patient Outcomes

DAAs have markedly improved hepatitis C outcomes, achieving cure rates above 90% with shorter treatment and fewer adverse effects compared to interferon-based therapies. Modern regimens are well tolerated and maintain kidney safety even when combined with other antivirals. Primary care providers and nurse practitioners now successfully manage many treatments, expanding access beyond specialists.

Challenges include managing side effects to ensure adherence and treatment completion. Overall, improved safety and efficacy support universal screening and wider treatment adoption.

Barriers and Global Access Challenges

Despite effective therapies, barriers impede hepatitis C elimination. Patient-level issues include lack of awareness, stigma, and poor adherence. Provider and system-level obstacles involve insurance restrictions, treatment eligibility limits, and inadequate healthcare infrastructure. Many countries restrict treatment to advanced disease stages, delaying cure.

Funding shortfalls, especially in low- and middle-income countries, limit program scale-up. Unlike HIV or malaria, hepatitis C has received less international funding, though successful national efforts like Georgia’s highlight the benefits of coordinated support. Drug prices remain a key barrier, with affordability affecting availability in many regions.

Addressing these challenges requires expanding community testing, enabling primary care treatment, and removing restrictions based on disease severity or substance use. Specialists remain important for complex cases and education.

Global Treatment Efforts and Future Directions

High-income countries have reduced financial barriers, such as removing co-payments for screening, but many middle- and low-income countries lag behind. Integrating hepatitis C care into universal health coverage and linking with HIV and primary care services are recommended to improve access.

Future efforts focus on developing new DAAs to overcome resistance, shortening treatment durations, and creating antifibrotic drugs to address liver damage. Continued innovation aims to improve safety, reduce costs, and simplify regimens.

Health system improvements, including increased funding, surveillance, and unrestricted treatment access, are essential. Early elimination programs in countries like Georgia and Australia demonstrate that policy and financing can accelerate progress toward WHO’s 2030 hepatitis C elimination goals.

The content is provided by Sierra Knightley, Scopewires