Global elimination of hepatitis C virus infection: Progresses and the remaining challenges

Abstract

Today, with the introduction of interferon-free direct-acting antivirals and outstanding progresses in the prevention, diagnosis and treatment of hepatitis C virus (HCV) infection, the elimination of HCV infection seems more achievable. A further challenge is continued transmission of HCV infection in high-risk population specially injecting drug users (IDUs) as the major reservoir of HCV infection. Considering the fact that most of these infections remain undiagnosed, unidentified HCV-infected IDUs are potential sources for the rapid spread of HCV in the community. The continuous increase in the number of IDUs along with the rising prevalence of HCV infection among young IDUs is harbinger of a forthcoming public health dilemma, presenting a serious challenge to control transmission of HCV infection. Even the changes in HCV genotype distribution attributed to injecting drug use confirm this issue. These circumstances create a strong demand for timely diagnosis and proper treatment of HCV-infected patients through risk-based screening to mitigate the risk of HCV transmission in the IDUs community and, consequently, in the society. Meanwhile, raising general awareness of HCV infection, diagnosis and treatment through public education should be the core activity of any harm reduction intervention, as the root cause of failure in control of HCV infection has been lack of awareness among young drug takers. In addition, effective prevention, comprehensive screening programs with a specific focus on high-risk population, accessibility to the new anti-HCV treatment regimens and public education should be considered as the top priorities of any health policy decision to eliminate HCV infection.

Keywords: Diagnosis; Elimination; Epidemiology; Hepatitis C virus; Injecting drug user; Prevention; Treatment; Vaccine.

Figure 1

Geographical distribution of hepatitis C virus genotypes. Hepatitis C virus (HCV) genotypes 1, 2 and 3 show a widespread distribution in almost all parts of the world. HCV genotype 4 has been restricted to a few countries in the Middle East and Africa. HCV genotype 5, 6 and 7 have been reported in South Africa, South East Asia and Central Africa, respectively[1,11,30,35,36].