Controversial aspects of HCV

This booklet includes aspects of care that are currently controversial and which may change as new information becomes available.

Price of drugs

The price of DAAs will continue to be the main barrier to widespread access and a universal cure.

DAAs could make HCV an historical medical problem. DAAs are cheap to manufacture but they are priced out of reach for high, low and middle-income countries.

Drugs in development

Given the high efficacy of current drugs, additional benefits from new drugs might mainly be the impact of greater competition on drug pricing.

How long to treat

DAAs are so effective and so expensive that some studies are looking at 8 rather than 12 weeks treatment.

This seems to work best in people who do not have cirrhosis, people with lower HCV viral loads and people who have never been treated for HCV.

However, if this involves adding a third DAA, there might be little cost saving and the risk for both side effects and drug interactions will increase.

Acute infection

The balance between early treatment and waiting for six months in case of natural clearance is further complicated by DAAs not being currently recommended in acute infection. These issues might be resolved in the future.

Retreatment

Usually, treating people for longer, and/or with DAAs from different classes, has worked in small groups of people.

HCV treatment for people who drink or inject drugs

This is despite guidelines that already recommend treatment. As more people are treated and cured, and with better access to clean injection equipment, methadone and buprenorphine, the less HCV will transmitted.

Sexual transmission

The mechanisms for why some HIV positive people have a higher risk of sexual HCV transmission will hopefully become more clear.

DAAs will reduce sexual transmissions as more people are cured. This will reduce the number of people who are still infectious. Avoiding reinfection is likely to continue to be important.