The Hepatitis C Virus Treatment Revolution-Can the Developing World Afford it?

Syed Amer, Amtul Hajira, Mohammed Muqeetadnan

Syed Amer, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona 85054, the United States
Amtul Hajira, Department of Family Medicine, Carle Foundation Hospital, Urbana, IL 61801, the United States
Mohammed Muqeetadnan, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, the United States

Correspondence to: Syed Amer, Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona 85054, the United States
Email: drsyedamer1@gmail.com
Telephone: +480-301-8000
Received: April 28, 2013
Revised: May 17, 2014
Accepted: May 20, 2014
Published online: June 21, 2014


Hepatitis C is the leading cause of hepatocellular carcinoma worldwide. Recently, several new, highly effective directly acting antivirals have entered the introduced in the market. But the high cost of these medications prohibits the widespread use in the developing world. We, through our paper would like to suggest steps towards making these medications widely available to the population that needs them the most.

Key words: Hepatitis C; Directly acting antivirals; Developing world

© 2014 The Authors. Published by ACT Publishing Group Ltd.

Amer S, HajiraA, Muqeetadnan M. The Hepatitis C Virus Treatment Revolution-Can the Developing World Afford it? Journal of Gastroenterology and Hepatology Research 2014; 3(6): 1131-1132 Available from: URL: http://www.ghrnet.org/index.php/joghr/article/view/741


Hepatitis C is a leading cause of chronic liver disease and hepatocellular carcinoma worldwide. According to the World Health Organization (WHO) about 130-150million people worldwide are affected with chronic Hepatitis C infection. 350,000 to 500,000 people die worldwide each year from hepatitis C related liver infection. Hepatitis C is a blood borne infection, commonly transmitted through use of unscreened blood products, sharing of needles in injection drug users, unprotected sex and rarely by perinatal transmission.

Hepatitis C virus encodes a highly error prone RNA polymerase, that leads to a great level of sequenceheterogeneity of the virus among the infected persons[1]. Interferon alfa and ribavarin have formed the crux of HCV treatment until recently. But these medications have been associated with undesirable side effects including cytopenias, rash and autoimmunity.

In recent months, several directly acting anti virals have been developed.These have been found to have increasing efficacy in eradicating HCV virus. Several directly acting antivirals (DAA) that are active against hepatitis C virus have been approved or are in the process of approval. Rarely, has mankind seen a definitive, curative therapy for a disease so extensive and devastating to human health as hepatitis C.

In 2013,United Statesfood and drug administration (US-FDA)approved Sofosbuvir, a nucleotide analogue HCV NS5B polymerase inhibitor[2]. Sofosbuvir treatment regimens are 12 weeks long for genotypes 1, 2 and 4. Treatment duration for genotype 3 is 24 weeks. This is known to have 90% success rate in patients with type 1 & 4 genotype and about 67% success rate in type 2 & 3 genotypes[3]. It is estimated that this medication will cost $ 84,000 for a 12 week course and $ 168,000 for a 24 week course.

Thus, the major challenge in eradicating Hep C in the developing worldis the high cost of the directly acting antivirals. The developing world accounts for 80% of the global HCV burden. Urgent steps need to be taken to ensure that the recent success against HCV reaches the world’s most needy and at risk population.

We suggest that the following steps should be taken by the international community for the widespread availability and success of anti HCV DAA in the developing world.

(a) Cost- effective screening programs; (b) Recognition of directly acting antivirals (DAAs) as essential medications; (c) Creating international funding streams and giving subsidies to the poor nations; (d) Generic manufacturing of DAA’s; (e) Global activism and political will; (f) Increasing public awareness regarding the widespread epidemic of HCV; We believe that making the developing world part of the HCV treatment revolution is imperative towards achievingthegoal of global eradication of HCV.


There are no conflicts of interest with regard to the present study.


1 Bartenschlager R, Lohmann V. Replication of hepatitis C virus. J Gen Virol 2000 Jul; 81:1631-1648

2 Lawitz E1, Mangia A, Wyles D, Rodriguez-Torres M, Hassanein T, Gordon SC, Schultz M, Davis MN, Kayali Z, Reddy KRetal.Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 2013 May 16; 368(20): 1878-1887

3 Stedman C.Sofosbuvir, a NS5B polymerase inhibitor in the treatment of hepatitis C: a review of its clinical potential. Therap Adv Gastroenterol 2014 May; 7(3): 131-140

Peer reviewesr: Arezoo Aghakhani, Clinical Research Department of Pasteur Institute of Iran; No 69, Pasteur Ave., Tehran, 13164, Iran; Mortada El-Shabrawi, 3 Nablos Street, Off Shehab Street, Mohandesseeen, 12411, Cairo, Egypt.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.