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The remarkable history of the hepatitis C virus

Genes & Immunity volume 20, pages 436–446 (2019)Cite this article

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Abstract

The infection with the hepatitis C virus (HCV) is an example of the translational research success. The reciprocal interactions between clinicians and scientists have allowed in 30 years the initiation of empirical treatments by interferon, the discovery of the virus, the development of serological and virological tools for diagnosis but also for prognosis (the non-invasive biochemical or morphological fibrosis tests, the predictors of the specific immune response including genetic IL28B polymorphisms). Finally, well-tolerated and effective treatments with oral antivirals inhibiting HCV non-structural viral proteins involved in viral replication have been marketed this last decade, allowing the cure of all infected subjects. HCV chronic infection, which is a public health issue, is a hepatic disease, which may lead to a cirrhosis and an hepatocellular carcinoma (HCC) but also a systemic disease with extra-hepatic manifestations either associated with a cryoglobulinemic vasculitis or chronic inflammation. The HCV infection is the only chronic viral infection, which may be cured: the so-called sustained virologic response, defined by undetectable HCV RNA 12 weeks after the end of the treatment, significantly reduces the risk of morbidity and mortality associated with hepatic and extra-hepatic manifestations, which are mainly reversible. The history of HCV ends with the pangenotypic efficacy of the multiple combinations, easy to use for 8–12 weeks with one to three pills per day and little problems of tolerance. This explains the short 30 years from the virus discovery to the viral hepatitis elimination policy proposed by the World Health Organization (WHO) in 2016.

The hepatitis C virus (HCV) infection is an example of the translational research success. The reciprocal interactions between clinicians and scientists have allowed in 30 years the initiation of empirical treatments by interferon, the discovery of the virus, the development of serological (ELISA, RIA) and virological (reverse transcriptase polymerase chain reaction or RT-PCR enabling the qualitative and quantitative detection of viral RNA, genotyping, resistance analysis such as basic virology) diagnostic tests with an increasing sensitivity and specificity. In parallel, non-invasive biochemical or morphological fibrosis tests, predictors of the specific immune response including genetic (IL28B) have been developed and finally, radically effective treatments with HCV-specific oral antivirals inhibiting non-structural viral proteins involved in viral replication have been marketed this last decade, allowing the cure of all infected subjects. The elimination agenda of the World Health Organization (WHO) illustrates these major advances but must not hide the global challenges of tomorrow. If the diagnosis, efficacy, and tolerability of treatment are no longer an issue, less than 1% of the 71 million infected individuals worldwide has been treated and the majority of patients are unaware of their infection: the next challenges are therefore mainly to improve the screening and access to treatment for this frequent infection, which represents a public health although that is the only viral chronic infection that can be cured.

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Authors and Affiliations

  1. Université Paris Descartes, Paris, France

    Stanislas Pol

  2. Département d’Hépatologie, Hôpital Cochin, APHP, Paris, France

    Stanislas Pol

  3. INSERM UMS-20, Institut Pasteur, Paris, France

    Stanislas Pol

  4. Immunobiologie des Cellules Dendritiques, Institut Pasteur, Paris, France

    Stanislas Pol & Sylvie Lagaye

  5. INSERM U1223, Institut Pasteur, Paris, France

    Stanislas Pol & Sylvie Lagaye

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  1. Stanislas Pol
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  2. Sylvie Lagaye
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Correspondence to Stanislas Pol or Sylvie Lagaye.

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SP has received consulting and lecturing fees from Bristol-Myers Squibb, Janssen, Gilead, MSD, Abbvie and grants from Bristol-Myers Squibb, Gilead, Roche and MSD. The remaining author declares that she has no conflict of interest.

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Pol, S., Lagaye, S. The remarkable history of the hepatitis C virus. Genes Immun 20, 436–446 (2019). https://doi.org/10.1038/s41435-019-0066-z

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  • DOI: https://doi.org/10.1038/s41435-019-0066-z

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