title: Why highly effective drugs are not enough: the need for an affordable solution to eliminating HCV.
abstract: Because of the rapid pace of development of new direct-acting antiviral (DAA) drugs, chronic hepatitis C virus (HCV) infection is now increasingly considered curable. However, the emphasis on DAA therapies disregards key issues related to cost, availability, and antiviral resistance. Areas covered: This perspective provides an overview of current HCV therapies and the development of DAAs, followed by a discussion of the limitations of DAA therapy. A literature search was used to select relevant studies, and a web search for relevant news articles and press releases was conducted. Expert commentary: Despite cure rates exceeding 90%, now is not the time to declare victory against HCV but to reinforce recent progress by addressing the issues of cost and availability as well as by developing strategies to manage antiviral resistance. Future drug development efforts should place greater emphasis on targeting host factors required for HCV replication, for which the barrier to resistance is higher, and effort should continue to develop a vaccine against HCV. Finally, efforts should be made to facilitate large-scale screening in endemic areas to identify and treat patients as early as possible to reduce long-term risks of advanced liver disease and their attendant costs of management.
authors.affiliation: a Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences , Hiroshima University , Hiroshima , Japan.|b Liver Research Project Center , Hiroshima University , Hiroshima , Japan.
authors.forename: C Nelson
authors.initials: CN
authors.lastname: Hayes
authors.affiliation: a Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences , Hiroshima University , Hiroshima , Japan.|b Liver Research Project Center , Hiroshima University , Hiroshima , Japan.|c Laboratory for Digestive Diseases, Center for Genomic Medicine , RIKEN , Hiroshima , Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D016527:Drug Costs; D015195:Drug Design; D024882:Drug Resistance, Viral; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage; D014779:Virus Replication
chemical_list: D000998:Antiviral Agents; D014761:Viral Hepatitis Vaccines
keywords: Direct-acting antiviral agents; NS5A inhibitor; host factors; interferon-free therapy; polymerase inhibitor; protease inhibitor; resistance-associated variants; sustained virological response