Barriers to Treatment of Hepatitis C Virus in the Direct-Acting Antiviral Era

Purpose of reviewHepatitis C Virus (HCV) is a major public health problem in the USA, accounting for more deaths than any other infectious disease. New infections have been on the rise in recent years because of increased parenteral transmission related to injection drug use and the opioid epidemic. Curative treatment for HCV is now available; however, many barriers to treatment still exist.Recent findingsDirect-acting antiviral (DAA) treatments have been available since 2011 in combination with interferon, and since 2014, as part of interferon-free regimens, and have greatly improved both safety and efficacy and made the prospects of HCV elimination possible. However, due to the initially high cost of these medications, factors related to younger individuals infected through injection drug use, and concerns about adherence and reinfection, access to treatment has been limited. Recent studies have documented barriers along the care continuum and have attempted to address these barriers to make treatment more widely available.SummaryHCV is a curable infection, and an opportunity exists to dramatically reduce the spread and consequences of this chronic infection with highly effective and well-tolerated treatment. Systemic, provider-related, and patient-related barriers have been identified; however, increased education, policy and advocacy, and innovative models of care may address these barriers. Expansion of HCV treatment efforts will need to be sensitive to these barriers.