Among patients in the acute phase of hepatitis C virus (HCV) infection, a portion will spontaneously clear the infection without treatment, and HCV RNA will completely disappear from the serum. Estimates from various studies project that anywhere from 20% to 30% of patients will spontaneously clear HCV, with the biggest factors being sex, ethnicity, immune status, and genetics.
For those who do not clear the infection on their own, direct-acting antiviral (DAA) agents have become available, and over 90% of patients undergoing treatment with these drugs will achieve a cure. The biggest drawback to DAA treatment is the cost, with 1 course of treatment in the United States ranging from $51,000 to $84,000.
The question then remains as to which patients should be targeted to receive treatment with DAAs, with the goal of not just reducing the number of individual HCV infections but also the public health burden of the disease in the future.