Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 28, 2015; 7(24): 2543-2550
Published online Oct 28, 2015. doi: 10.4254/wjh.v7.i24.2543
Era of direct acting antivirals in chronic hepatitis C: Who will benefit?
James Fung
James Fung, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
James Fung, Liver Transplant Center, Queen Mary Hospital, Hong Kong, China
James Fung, State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
Author contributions: Fung J solely contributed to this work.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: James Fung, Consultant, Honorary Clinical Associate Professor, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Telephone: +852-2-2553830 Fax: +852-2-8725828
Received: May 4, 2015
Peer-review started: May 5, 2015
First decision: June 3, 2015
Revised: September 7, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: October 28, 2015

In the era of highly effective direct acting antiviral (DAA) drugs for the treatment of chronic hepatitis C (CHC) infection, where eradication is almost ensured with minimal side effects, all hepatitis C carriers should benefit theoretically. In the real world setting however, only a small proportion will benefit at this time point due to the multiple barriers to accessing therapy. Given that universal treatment is unlikely, treatment with DAAs will likely be restricted to those with the highest health benefits, and for those who can afford the high expense of a treatment course. Those with the highest unmet needs include those who have failed previous interferon-based therapy or who are interferon-ineligible with evidence of active disease, those with advance liver disease, and those with recurrence of hepatitis C after liver transplantation. In the future, the focus should be on increasing access to treatment for those infected with CHC.

Keywords: Treatment, Direct acting antivirals, Benefit, Unmet needs, Cirrhosis, Liver transplantation, Chronic hepatitis C

Core tip: Chronic hepatitis C has become an easily curable disease with new direct acting antivirals (DAAs). However, due to multiple barriers to therapy, only those with highest unmet clinical needs including those with prior treatment failure, cirrhosis, and post-liver transplant, will likely receive therapy. DAAs have been shown to be highly efficacious in these groups.