Hepatitis C in 2019: Are We There Yet?

Chronic hepatitis C is the most common blood-borne pathogen worldwide. Upwards of half of the individuals infected with hepatitis C have not been diagnosed, and rates of screening remain low. Incidence, which had been declining, began increasing in 2011, mirroring the current opioid epidemic. Once infected, people with chronic hepatitis C are at risk for developing complications including end-stage liver disease and hepatocellular carcinoma, leading to morbidity and mortality. These public health consequences of the hepatitis C epidemic are expected to increase over the coming decade. Innovation has resulted in highly tolerable medications of 8 to 16 weeks’ duration with over 90% efficacy. Experts have determined that the eradication of hepatitis C would be feasible and have laid out strategies to move us toward that goal. Significant and disparate barriers remain, including access to treatment and an increase in incidence related to the opioid epidemic. An underresourced approach to surveillance and screening, provider shortages, and payer restrictions are among the obstacles to eliminating hepatitis C as a public health problem in the United States.