Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2022; 14(1): 1-44
Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.1
Hepatitis C virus: A critical approach to who really needs treatment
Elias Kouroumalis, Argyro Voumvouraki
Elias Kouroumalis, Department of Gastroenterology, University of Crete Medical School, Heraklion 71500, Crete, Greece
Argyro Voumvouraki, First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
Author contributions: Kouroumalis E devised the paper, wrote the draft and reviewed the literature; Voumvouraki A collected the literature and finalized the draft.
Conflict-of-interest statement: There is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Elias Kouroumalis, MD, PhD, Emeritus Professor, Department of Gastroenterology, University of Crete Medical School, Voutes, Heraklion 71500, Crete, Greece.
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: March 29, 2021
Revised: April 14, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: January 27, 2022

Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.

Keywords: Hepatitis C, Comorbidities, Screening and treatment policy, Hepatitis C virus, Review

Core Tip: Elimination of hepatitis C virus (HCV) by 2030 according to the World Health Organization policy seems highly unlikely because of the funding re-direction due to the coronavirus disease 2019 pandemic. It is important therefore to re-evaluate the treatment policies based on a more realistic and feasible approach. HCV disease has a very prolonged natural course, and even HCV-related cirrhosis has a lower mortality compared to other cirrhosis etiologies. However, liver related morbidity and mortality is increased when certain comorbidities accompany the initial HCV infection. A review of the current knowledge allows for a more or less accurate identification of these comorbidities. Therefore, an eradication program is proposed based on screening and treating only these particular groups.