Hepatitis C Elimination: The 95% Cure and the Race to Meet WHO's 2030 Target

How Effective Are Current Hepatitis C Treatments?

The development of direct-acting antivirals (DAAs) has transformed hepatitis C from a chronic, progressive disease often leading to cirrhosis, liver cancer, and death into a curable condition. Before DAAs, treatment relied on pegylated interferon and ribavirin, a regimen that required 24-48 weeks of injections, caused severe side effects (flu-like symptoms, depression, anemia), and achieved cure rates of only 40-50%. The first DAAs, approved in 2013-2014, represented a paradigm shift, and current pangenotypic regimens are effective against all major HCV genotypes (1-6).

Two pangenotypic regimens dominate current treatment. Sofosbuvir/velpatasvir (Epclusa), developed by Gilead Sciences, is a once-daily fixed-dose combination tablet taken for 12 weeks that achieves sustained virologic response (SVR, effectively a cure) rates of 95-99% across all genotypes. Glecaprevir/pibrentasvir (Mavyret), developed by AbbVie, is taken as three tablets once daily for 8 weeks in treatment-naive patients without cirrhosis, with SVR rates exceeding 97%. Both regimens are well-tolerated, with the most common side effects being headache, fatigue, and nausea, and drug-drug interactions being the primary clinical consideration.

Achievement of SVR, defined as undetectable HCV RNA 12 weeks after completing treatment, is effectively a cure, as late relapse is exceedingly rare (less than 1%). Cure halts liver fibrosis progression, can lead to regression of fibrosis and even early cirrhosis, dramatically reduces the risk of hepatocellular carcinoma, and eliminates the risk of onward transmission. Studies published in The Lancet have shown that HCV cure reduces all-cause mortality by approximately 50% and liver-related mortality by over 70%, making it one of the most impactful treatments in modern medicine.

Why Is Hepatitis C Elimination by 2030 Still a Challenge?

The WHO set ambitious targets in 2016 to eliminate hepatitis C as a public health threat by 2030, defined as a 90% reduction in new infections and a 65% reduction in HCV-related deaths compared to 2015 levels. As of 2024, only 13 countries are on track to achieve these targets. Globally, an estimated 1.5 million new HCV infections still occur annually, and approximately 290,000 people die from HCV-related liver disease each year, predominantly from cirrhosis and hepatocellular carcinoma.

The single largest barrier to elimination is the diagnosis gap. The WHO estimates that only about 36% of people living with hepatitis C globally have been diagnosed. In many high-burden countries, routine HCV screening is not integrated into primary healthcare, and many infected individuals, particularly people who inject drugs, incarcerated populations, and migrants from endemic regions, face barriers to testing. The US Preventive Services Task Force (USPSTF) expanded its recommendation in 2020 to screen all adults aged 18-79 at least once, but implementation has been inconsistent.

Cost remains a significant obstacle in many low- and middle-income countries. When sofosbuvir was first launched in 2013, its price was $1,000 per pill ($84,000 for a 12-week course) in the United States, generating enormous controversy. While generic DAAs are now available for as little as $50-100 for a full treatment course in many developing countries through voluntary licensing agreements, access remains uneven. High-income countries continue to face high prices, and some national health systems restrict treatment to patients with advanced liver disease due to budget constraints, a medically and ethically problematic approach that perpetuates transmission.

How Has Egypt Become a Global Leader in Hepatitis C Elimination?

Egypt's hepatitis C epidemic was one of the world's most severe, stemming largely from mass parenteral antischistosomal therapy (PAT) campaigns in the 1950s-1980s that inadvertently transmitted HCV through reuse of improperly sterilized glass syringes. By 2015, Egypt had an estimated HCV prevalence of 7-10% among adults (approximately 6-8 million people), the highest national prevalence in the world. The predominantly genotype 4 infection caused an enormous burden of chronic liver disease, with HCV being the leading cause of liver transplantation and liver cancer in the country.

In 2018, President Abdel Fattah el-Sisi launched the "100 Million Healthy Lives" campaign, an unprecedented national initiative to screen the entire adult population for hepatitis C (and also for diabetes, hypertension, and obesity). Over a period of approximately 18 months, more than 60 million Egyptians were screened using rapid HCV antibody tests, with positive results confirmed by PCR testing. Those found to be infected were linked to treatment through a network of over 100 treatment centers established by the National Committee for Control of Viral Hepatitis (NCCVH), which had negotiated DAA prices of approximately $84 per treatment course through direct deals with generic manufacturers.

The results have been remarkable. More than 4 million Egyptians have been treated and cured, with SVR rates exceeding 95%. National HCV prevalence has dropped to below 1%, and Egypt is widely recognized as the country closest to achieving the WHO 2030 elimination targets. The Egyptian model demonstrates that elimination is achievable even in heavily burdened countries when there is strong political will, dedicated funding, simplified treatment protocols, decentralized care delivery, and affordable medication. The WHO and other organizations have cited Egypt as a model for other high-burden countries.