Global elimination of hepatitis C virus by 2030: The pessimistic view

While Hepatitis C virus (HCV) infection meets criteria for elimination, current screening strategies globally are inadequate and resource allocation for screening and treatment is largely inadequate, particularly in resource-constrained countries. The observed effectiveness of direct-acting antiviral therapy has raised the theoretical possibility of HCV elimination. One indicator of the likelihood of achieving HCV elimination is the effectiveness of current screening and treatment recommendations and policies. Considering the absence of an effective vaccine, the most critical tool in the elimination of smallpox infection, the primary prevention of HCV transmission is as important as treating those already infected in any HCV elimination strategy. The effect of prevention interventions on incidence of HCV infection is primarily dependent on local epidemiology. Restricting treatment to only those with advanced fibrosis ignores the morbidity associated with chronic infection, including fatigue, and the extrahepatic complications, such as lymphoma.