Viral Hepatitis C Pandemic: Challenges and Threats to Its Elimination

Laura Krekulova; Radkin Honzák; Lee W. Riley


J Viral Hepat. 2021;28(5):694-698. 

In This Article

Abstract and Introduction


Under the WHO plan, the global elimination of the HCV pandemic is scheduled for 2030. The burden of HCV infection in developed countries is largely borne by people who inject drugs (PWID): new infections and reinfections are related to their risky behaviour. Although safe and sensitive hepatitis C diagnostic tools and directly acting antiviral medication are widely used, major challenges to disease elimination still remain in developed countries, where the WHO plan is in progress. The challenge is in the involvement and engagement of infected PWID. There is a strong need to change our uptake and treatment strategies to address all patients from the risk groups, connect them with the healthcare system and cure them with the vision to eliminate this HCV pandemic.


Based on the latest estimate, 1% of the world's population is chronically infected with hepatitis C virus. Around 71 million people live with hepatitis C.[1,2] Viral hepatitis C is the chief cause of liver-related deaths responsible for more than 670,000 annually.[3] The viral hepatitis C pandemic is unevenly distributed geographically with varying distribution of HCV genotypes. Unsafe healthcare procedures (in developing countries) and injecting drug use (in developed countries) are the leading causes of new HCV infections.

The global incidence of HCV infection was estimated to be about 1.75 million in 2015[1] and more than 23% of those new cases occurred among people who inject drugs (PWID)[2,4–6] associated with sharing needles and syringes. Being PWID has been identified as a risk factor for HCV transmission.[4,8,9] There is a considerable burden of HCV infection among people with a history of injecting drug use, including those receiving opioid substitution therapy (OST). Some OST programme clients may even continue to inject drugs.

According to the latest estimate from 2019, of 71 million HCV-infected subjects, 6.1 million are PWID.[10,11] In Europe, two-thirds of the new HCV infection cases are related to injecting drug use.[12] The global prevalence of HCV infections among PWID is approximately 40%.[4,13]