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

  • Christian B. RamersEmail author
  • Jie Liu
  • Catherine Frenette
Hepatitis C (J Raybould, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hepatitis C


Purpose of review

Hepatitis 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 findings

Direct-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.


HCV 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.


Hepatitis C (HCV) People who Inject Drugs (PWID) Barriers Direct Acting Antivirals (DAA) 


Compliance with Ethical Standards

Conflict of Interest

Dr. Frenette reports personal fees from Gilead, personal fees from Abbvie, personal fees from Merck, personal fees from Bristol Meyers Squibb, outside the submitted work.

Dr. Ramers reports grants and personal fees from Gilead Sciences, personal fees from AbbVie, personal fees from Merck, outside the submitted work.

Dr. Liu declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Christian B. Ramers
    • 1
    • 2
    Email author
  • Jie Liu
    • 1
  • Catherine Frenette
    • 3
  1. 1.Family Health Centers of San DiegoSan DiegoUSA
  2. 2.University of CaliforniaSan DiegoUSA
  3. 3.Scripps Green HospitalLa JollaUSA

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