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In view of the continued rapid progress in the development of new treatments for hepatitis C infection, the World Health Organization (WHO) is issuing updated treatment guidelines. The guidelines promote the transition to newer, more effective medicines that have the potential to cure most persons living with hepatitis C infection.
WHO issued its first-ever recommendations on the treatment of hepatitis C virus (HCV) in 2014. Since then, several new medicines have been introduced and marketed. These medicines, called direct-acting antivirals (DAAs), are more effective and easier to use than established treatment regimens. Furthermore, they have been included in WHO’s Model List of Essential Medicines. Treatment with DAAs is short in duration (8–12 weeks), easy to take (as few as one pill per day), has few side effects, and results in a cure for more than 90 percent of people treated. This is a vast improvement from older treatments, which cured less than half of the people treated, required weekly interferon injections for up to 12 months, and often resulted in severe, sometimes fatal, side effects.
The new guidelines also provide guidance on which specific regimens should be used (called "preferred regimens") based on a patient’s clinical history as well as the genotype of HCV (there are six genotypes). These preferred regimens simplify treatment decisions by recommending only three treatment regimens for patients without cirrhosis and an additional two for patients with cirrhosis.
The updated guidelines are intended to promote the scale-up of HCV treatment, particularly in low- and middle-income countries where few people currently have access to hepatitis treatment, despite also being where most people with HCV live. WHO recognizes that implementation of the recommendations may not be immediate, because the treatments can be expensive and the medicines are not yet approved in many countries.
The price of DAAs varies dramatically. The cost to treat a single patient in some high-income countries can exceed $100,000. However, following the introduction of generic versions of DAAs, the price in other countries, such as India, is less than $500 to treat a single patient.
Approximately 130 million to 150 million people are estimated to be infected with HCV. Each year, an estimated 700,000 people die from HCV-related complications including fatty liver (cirrhosis), cancer (hepatocellular carcinoma) and liver failure. Unfortunately, many people with HCV only learn about their infection when they develop symptoms from cirrhosis or liver cancer.
Because the prices are rapidly dropping, and because the medicines are easy to use, they have the potential to dramatically reduce the number of deaths due to hepatitis C infection.