Hepatitis C virus (HCV) is a major global health problem. WHO estimates that 71 million people worldwide are chronically infected with HCV. Of those, 2.3 million people are coinfected with the human immunodeficiency virus (HIV) and HCV. In 2015, around 400 000 people died of HCV-related liver disease, and evidence indicates that the HCV burden is increasing.
Direct acting antivirals (DAAs) have revolutionized treatment for hepatitis C. Combinations of DAAs can cure infection with HCV in 12 weeks, are highly effective and have limited side-effects. Pan-genotypic combinations (that are effective against all genotypes of HCV) have started to become available; they can contribute to the simplification of both the diagnostic and treatment algorithm, which would enable treatment to be rolled out in resource-limited settings.
The market for direct-acting antivirals (DAAs) has significantly changed in the few years since they were launched. The relative importance of regimens is becoming clearer. New DAAs and combinations thereof continue to be launched, expanding the number of regimens. Nevertheless, to date, sofosbuvir still is the backbone of most regimens.
DAAs are becoming available in more low- and middle-income countries, although the pace should be quickened. There is still a long way to go until all key products are registered and launched in all countries.