Global HCV Elimination Goals at Risk as 70% of Target Population Remains Untreated

Recent research is shedding light on regional and temporal variations in hepatitis C virus (HCV) treatment patterns across 119 countries and regions from 2014 to 2023, calling attention to the need for expanded access, active HCV screening, and linkage to care in order to achieve the World Health Organization (WHO)’s target to eliminate HCV by 2030.¹

Using national HCV registries, reported direct-acting antiviral (DAA) sales data, pharmaceutical companies’ reports, and estimates provided by national experts, the study found that nearly 13 million individuals have been treated with DAAs in the last 10 years, which accounts for 21% of the starting 62 million people with chronic infection and 30% of the target population taking into consideration 90% diagnosis and 80% treatment targets.¹

“The paper by the Polaris Observatory is highly relevant to the field, as it provides important estimates for HCV treatment access and highlights key challenges in achieving the WHO’s 2030 elimination goals as per the latest Global Health Sector Strategy,” wrote Heiner Wedemeyer, MD, a professor and chairman of the department of gastroenterology, hepatology, infectious diseases and endocrinology at Hannover Medical School, in an accompanying editorial.²

For more on progress and persistent challenges in eliminating HCV, check out the latest episode of Liver Lineup with Drs. Nancy Reau and Kimberly Brown: Liver Lineup: Progress, Policy, and Barriers in Hepatitis C Elimination

Investigators from the Polaris Observatory used national HCV registries, reported DAA sales data, pharmaceutical companies’ reports, and estimates provided by national experts to estimate the number of people living with HCV (PLHCV) treated between 2014–2023 across 119 countries. For the countries with no available data, the average estimate of the corresponding Global Burden of Disease region was used.¹

An estimated 13,816,000 (95% uncertainty interval [UI], 13,221,000–16,415,000) PLHCV were treated, of whom 12,748,000 (UI, 12,226,000–15,231,000) were treated with DAAs, of which 11,081,000 (UI, 10,542,000–13,338,000) were sofosbuvir-based DAA regimens. In the last 10 years, 21% of the starting 62 million HCV infections were treated with DAAs.¹

Investigators observed a rapid switch to DAAs in 2015, when they were approved widely, and a peak in 2019 due to the expansion of the Egyptian HCV elimination program that year. Annual regional and global estimates of DAA treatment indicated high treatment in WHO’s Eastern Mediterranean region, lower middle-income group, and Asia.¹

Of note, Egypt, Pakistan, the United States, and the European Union accounted for 67% of all HCV treatments.¹

In high-income countries, results showed the number of treatments peaked in 2016, but it had already declined by 8% before the COVID-19 pandemic in 2020 resulted in a further 29% decline. Similarly, in lower middle-income countries, except for Egypt, treatment peaked in 2016 and declined by 22% before the COVID-19 pandemic resulted in an additional 44% decline in 2020.¹

However, COVID-19’s impact in the other regions was less pronounced. In 2020, treatment increased by 16% in upper middle-income countries and 650% in low-income countries.¹

Investigators also called attention to a significant relationship between DAA prices and access to treatment initiations, notably in low- and middle-income countries, where price played an important role in expanding treatment access through the public and private markets. In high-income countries, there was a 41% drop in treatment from its peak, and reimbursement was found to be a large predictor of treatment.¹

“HCV is a curable chronic infectious disease and elimination is feasible – if it is prioritized and treatment is implemented using principles of public health. This study shows the progress and the remaining gaps and highlights that there are still insufficient countries leading the way. With only around 6 years left until 2030, national responses need to be accelerated,” Wedemeyer wrote.²

References

1. The Polaris Observatory Collaborators. Number of people treated for hepatitis C virus infection in 2014-2023 and applicable lessons for new HBV and HDV therapies. Journal of Hepatology. 10.1016/j.jhep.2025.01.013
2. Luhmann N, Wedemeyer H. More than 10 years of IFN-free HCV treatment and viral hepatitis elimination: Mission not completed! Journal of Hepatology. 10.1016/j.jhep.2025.03.029