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J Hepatol. 2018 Nov;69(5):1188-1196. doi: 10.1016/j.jhep.2018.06.016. Epub 2018 Jun 28.

The removal of DAA restrictions in Europe - One step closer to eliminating HCV as a major public health threat.

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The Kirby Institute, UNSW Sydney, Sydney, Australia. Electronic address:
National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France.
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Italy.
The Kirby Institute, UNSW Sydney, Sydney, Australia.


Of ∼10.2 million people with chronic HCV infection in Europe, 6.7 million live in Eastern Europe, 2.3 million in Western Europe and 1.2 million in Central Europe. HCV transmission continues to occur in parallel with an increasing HCV-related liver disease burden, the result of an ageing population infected during peak HCV epidemics decades earlier. In 2016, the World Health Organization set targets to eliminate HCV infection as a major public health threat by 2030. Across Europe, an estimated 36% of those living with chronic HCV infection have been diagnosed and ∼5% have been treated. A major barrier to enhancing HCV treatment uptake has been restrictions set by payers, including national governments and others, in response to the initially high list prices of direct-acting antiviral (DAA) therapies. The aims of this article are to discuss DAA restrictions in Europe, why DAA restrictions are still in place, what has facilitated the removal of DAA restrictions, and what challenges remain as we attempt to eliminate HCV as a major public health threat in the region by 2030.


Access; Elimination; Europe; Fibrosis; General practitioners; Hepatitis C virus; People who use drugs


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