I worked for 5 years doing epidemic modeling for HCV, from right around when the first generation of the modern treatments became available (Sofosbuvir, etc). When I started working it was immediately clear that Sofosbuvir et al were a total game changer, and for a while my research was based on figuring out who to treat first: people very sick but that were not spreading the disease, or people with few symptoms that were actively spreading the disease
Here are a few interesting things (in my opinion) that are not so well known about HCV:
- Prior to 2015 you could cure HCV, the standard of care was ribavirin with pegylated interferon. If you were lucky and had the right HCV genotype you would take a whole bunch of pills and injections for 48 weeks, with a 50% chance of cure. The side effects were pretty bad though, people I met that took it compared it to chemo.
- Currently there are treatments available that will cure any HCV genotype, on people with advanced liver disease (cirrhotic), coinfected with HIV, with >95% success rate. One pill per day with basically no side effects.
- In western countries there are a whole bunch of HCV positive baby boomers, in many cases unaware that they are infected. Epidemically they are not transmitting the disease, but they have been chronic for many years and are having liver issues
- Again in western countries, the epidemic is being driven mostly by active intravenous drug users, typically young, and often with other co-morbidities (mental health issues, HIV, etc). Re-infection is possible, so HCV eradication will be tough
- There is controversy as to whether you can transmit HCV sexually, at the least it is much harder than transmitting HIV. Conversely active intravenous drug users that share needles will almost certainly have HCV, with HIV being harder to transmit this way
- In other countries the situation can be very different. Egypt in particular has around 20% HCV prevalence, the story goes that the UN funded a program to eliminate schistosomiasis in the 1980s via vaccination, but the campaign did a lot of shared needles
AMA I guess