1Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Hartford, USA.
Hepatitis C virus (HCV) infection remains a significant medical concern in the United States and around the world. It is still one of the leading causes of chronic liver disease, and, for more than 20 years, there has been little progress in the treatment of HCV infection. The advent of direct-acting antivirals (DAAs) initiated the era of high efficacy and well-tolerated medications with high cure rates. The efficacy of these medications has prompted many professional societies around the world to update their treatment guidelines to include DAAs as first-line treatment. Guidelines by the American Association for the Study of Liver Disease/Infectious Disease Society of America, World Health Organization, Asian-Pacific Association for the Study of Liver and the European Association for the Study of Liver have all incorporated DAAs into their treatment guidelines. Despite the promising data supporting these medications, however, their cost represents a limiting factor to their use, even though studies have shown DAAs to be cost-effective. In addition to the expense of these medications and limited resources, there are many barriers preventing patients from receiving this potentially life-saving treatment. In order to overcome these barriers, these issues need to be recognized and addressed.