On the Possibility of Eradicating Hepatitis C in Russia

Long-term efforts of the international community led to the development of highly efficient direct-acting antivirals (DAAs) that allow treatment of the vast majority of patients with chronic hepatitis C. The proteins encoded in the genome of the hepatitis C virus (HCV) that play a key role in its life cycle (NS3, NS5A, and NS5B) are the targets of this type of drug. There are three classes of DAAs each of which is directed to the inhibition of a specific target protein. Since the HCV has a sufficiently high rate of accumulation of mutations, the development of resistance to these drugs is a big problem. The current recommended treatment regimens with DAAs without the use of interferon and ribavirin are a combination of drugs of different classes providing an increase in the barrier of resistance. Due to the emergence of DAAs, a number of countries (WHO members, with the involvement of Russia) put forward a global strategy to eradicate the HCV. Taking into account the high cost of DAAs and a large number of HCV-infected individuals in Russia, achieving the goals declared by the WHO presents great financial difficulties for our country. However, federal funds allocated for hepatitis C therapy increased significantly over the past 3 years. In addition to increased funding, there is a great potential for reducing the cost of treatment, but its implementation is impossible without the organization of national production of quality generics, issuance of compulsory licenses (given that it is impossible to negotiate with patent holders on licensing), and/or negotiations on price reduction in exchange for volume (for example, the experience of Australia and Portugal). Anyways, Russia faces a very important task to provide therapy for several million patients with hepatitis C in the coming years to get closer to the goal of eradication of the HCV set by the international community.