The evolution of hepatitis C virus (HCV) treatment has been swift, dazzling, and unprecedented, says a Pipeline Report. In only five years, proof of concept for oral, interferon-free treatment has been established, nine direct-acting antivirals (DAAs) have been approved, treatment duration has been shortened to 12 weeks, and cure rates have been nearly 100% in clinical trials.
Scaling up access to these wonder drugs – and primary prevention – could eliminate HCV, even without a vaccine. Unfortunately, sky-high DAA prices have created a paradox: the more treatment improves, the fewer people have access to it.
The report says a public health approach will be needed to select, procure, and deliver HCV treatment. It is time to pick a first-line regimen, consider options for second-line treatment, and turn up the pressure for universal access to HCV treatment.
Worldwide, 185m people have been infected with hepatitis C; 73% of them live in middle-income countries (MICs). Pharmaceutical companies see MICs as emerging markets, even though they are home to the “bottom billion” – 73% of the world’s poorest people.6 MIC governments cannot afford DAAs for everyone who needs them.
The report says the price of DAAs in the US should not be the benchmark anywhere – even in the US. In high-income countries (HICs), payers have been withholding treatment for hepatitis C, citing sofosbuvir’s scandalous launch price ($1,000 per pill). People who drink alcohol or who use and inject drugs are often ineligible for treatment.
HCV guidelines have been deliberately misinterpreted to justify withholding treatment. DAAs are given only to people with advanced liver disease, to stave off liver cancer, liver failure, transplantation, and death. Limiting HCV treatment access to people with advanced liver damage will stem liver-related mortality, but not epidemics, the report argues.Pipeline Report material