Only 25 years from the discovery of the hepatitis C virus, a cure is now likely for most people afflicted with this chronic infection. The recent approval of several direct-acting antiviral agents has dramatically increased the viral clearance rate to over 90%. As Dr Eugene Schiff says, once treatment programs get going, in thirty years, the disease could be expected to be eradicated.

 

　　However, barriers exist on the road to curing HCV infection. According to Dr T. Jake Liang in an interview with APASL Daily, “cost is a major challenge.” Dr Liang is a former President of AASLD2011, from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, USA. He gave an excellent speech on the topic of Challenges and Prospects of HCV Therapy Beyond the DAAs at APASL2016. He told APASL Daily that with the current price of the drugs, many people and countries of low- to mid-income level couldn’t afford them. “The cost of treatment would have to go down significantly first before we can consider eradication”, said by Dr. Liang.

 

　　Additionally, diagnosis and access to appropriate healthcare and treatment for the majority of people infected with HCV is another major problem. Other challenges include further reducing the treatment duration, and who should to be treated and with what regimen. Also, there remain difficult-to-treat patient populations.

 

　　To address these remaining challenges, one of the options is to develop new drugs targeting other viral or host factors.

 

　　“The cost of treatment would have to go down significantly first before we can consider eradication”.

 

　　When asked his opinion on the role of host-targeting agents for treating hepatitis C, Dr. Liang believes it is a viable alternative to DAAs “because host-targeting agents have less of an issue with drug resistance and are likely to be active against all HCV genotypes. The miR-122 inhibitor sounds promising in early clinical trials. Entry inhibitors such as antibody or small molecule-based therapeutics have shown promise not only as preventive but also in therapeutic strategies.”

 

　　Also Dr. Liang believes that a vaccine is necessary to prevent new infections, especially in high-risk populations or high-prevalence countries. “However, the lack of convenient animal models to test vaccine candidates is probably the most significant barrier to the development of an effective vaccine. The other barrier to development of an effective HCV vaccine is a dearth of funding opportunities in both the private and public sectors.”