1Duke Clinical Research Institute, Duke University School of Medicine; Division of Gastroenterology, Department of Medicine, Duke University School of Medicine. Electronic address: firstname.lastname@example.org.
2Duke Clinical Research Institute, Duke University School of Medicine; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine.
The recent advances in hepatitis C virus (HCV) therapeutics have brought combinations of direct acting antiviral medications that offer interferon-free, well-tolerated regimens with sustained virologic response rates over 90% in clinical trials for many patient groups. The successes have prompted discussions regarding cure for all patients. These regimens have already demonstrated the ability to cure previously challenging patient groups, including HIV-HCV co-infection, decompensated cirrhosis and post-liver transplantation. Limitations exist in the current portfolio of agents with suboptimal outcomes for genotype 3 and limited data in genotypes 5 and 6. More data are urgently needed in patients with chronic kidney disease and in children. With ongoing developments, highly effective regimens for all these patients groups are within reach. In order to deliver HCV treatment throughout the world and particularly in low and middle income countries, regimens need to be affordable but also pangenotypic, well tolerated and delivered once daily for 4 to 8 weeks. With such a regimen, cure for all patients would then hinge on the ability to identify patients with HCV infection and deliver treatment within their communities. This review will discuss the strategies that will be necessary to realize this opportunity to cure all persons with HCV infection.