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World J Gastroenterol. Apr 28, 2021; 27(16): 1728-1737
Published online Apr 28, 2021. doi: 10.3748/wjg.v27.i16.1728
Hepatitis C virus micro-elimination: Where do we stand?
Alessandra Mangia, Rosa Cotugno, Giovanna Cocomazzi, Maria Maddalena Squillante, Valeria Piazzolla
Alessandra Mangia, Rosa Cotugno, Giovanna Cocomazzi, Maria Maddalena Squillante, Valeria Piazzolla, Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Fg, Italy
Author contributions: Mangia A designed the review, supervised the drafting of the manuscript, and finalized the version for publication; Cotugno R and Squillante MM searched the literature and collected the references; Piazzolla V and Cocomazzi G wrote the first draft of the manuscript.
Conflict-of-interest statement: Mangia A has served in an advisory role and received research grants from Gilead Sciences, MSD, Intercept, and Spring Bank; all other authors declare having no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandra Mangia, MD, Chief Doctor, Liver Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo 71013, Fg, Italy. a.mangia@tin.it
Received: January 14, 2021
Peer-review started: January 14, 2021
First decision: February 10, 2021
Revised: February 28, 2021
Accepted: April 5, 2021
Article in press: April 5, 2021
Published online: April 28, 2021
Abstract

Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviral treatments, has been promoted by the World Health Organization. This achievement is not attainable, however, particularly after the 2020 pandemic of the coronavirus disease 2019. Consequently, the more realistic objective of eliminating HCV from population segments for which targeted strategies of prevention and treatment are easily attained has been promoted in Europe, as a valid alternative. The underlying idea is that micro-elimination will ultimately lead to macro-elimination. The micro-elimination strategy may target different specific populations and at-risk groups. Different settings, including prisons and hospitals, have also been identified as micro-elimination scenarios. In addition, dedicated micro-elimination strategies have been designed that are tailored at the geographical level according to HCV epidemiology and individual country’s income. The main elements of a valid and successful micro-elimination project are reliable epidemiological data and active involvement of all the stakeholders. Community involvement represents another essential component for a successful program.

Keywords: Hepatitis C virus antibodies, Hepatitis C virus elimination, Hepatitis C virus epidemiology, Hepatitis C virus RNA, Hepatitis C virus diagnosis, Hepatitis C virus infection

Core Tip: Achievement of hepatitis C virus (HCV) elimination using direct-acting antiviral drugs treatment by 2030 promoted by World Health Organization is hardly attainable especially amidst the coronavirus disease 2019 pandemic. The smaller goal of eliminating HCV from population segments for which tailored strategies of prevention and treatment can be easily implemented appears more realistic. Different specific populations and at-risk groups, as well as different settings including prisons and hospitals have been selected for micro-elimination campaigns. Dedicated micro-elimination strategies have also been designed at geographical level according to the countries income and HCV epidemiology. The success of micro-elimination depends on reliable epidemiological data and active involvement of all the different stakeholders.