| The World Health Organization (WHO) aims to eliminate viral hepatitis as a public health threat by 2030. This ambitious objective includes safe injections in 90% of cases, harm reduction in 75% of people who inject drug, and HCV treatment coverage of 80% worldwide. In this context, it seems possible, at least in certain areas, to control, possibly to eradicate HCV infection. Indeed, new HCV treatment regimens based on safe and well-tolerated pangenotypic HCV direct-acting antiviral (DAA) drug combinations, including sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, yield very high cure rates (>99%) in most groups of patients with chronic hepatitis C. Triple combination of a nucleotide analogue, an NS5A inhibitor and a protease inhibitor can now be used to retreatment patients who failed a DAA-containing regimen with a high probability of HCV infection cure. Recent international society guidelines provide worldwide treaters with useful guidance to optimize the results of antiviral therapy. Reasonable HCV elimination targets include the prevention of transmission (through safe blood and blood products, safe injections and micro-elimination approaches in high-risk groups) and the cure of the HCV infection in patients who are already infected. Accurate estimates of the HCV prevalence and incidence in the area is required. Because most patients are unaware of their infection, screening strategies adapted to the local environment must be put in place in order to link patients to care. Then, the cascade of care must be optimized through active simplification and linkage, an easier challenge with the arrival of pangenotypic drug combinations and the simplification of diagnostic and monitoring procedures. As a result, there is a need to raise awareness and broaden the range of treaters in order to provide better access to care through national elimination plans involving multiple stakeholders. |
