Hepatitis C drugs are saving lives, but making the most of them

Despite safe and effective treatment of hepatitis C virus (HBV), less than 3% of people in the world who have been infected for a long time have accepted them.

Now, a series of new research provides reasons to expand access to these drugs and hopefully use functional treatments. From slowing liver damage to triggering immune defenses through next-generation RNA therapy, the researchers believe it is time to rethink how and when to treat this silent killer. John Tavis (Ph.D., a virologist at St. Louis University School of Medicine.

Millions of risks, but treatment still cannot reach

In two companion articles Lancet Gastroenterology and Hepatologyinternational experts advocate expanding the treatment guidelines for hepatitis C. The virus usually kills more than 3,000 people every day through invisibility. People who are infected at birth may quietly keep it silent for decades until liver cancer or cirrhosis occurs. Still, treatments usually come late, or not at all.

“Less than 3% of all people with HBV are receiving treatment,” said Tavis, co-author of the two papers. “If we had drugs earlier, there would be much less net disease and mortality.”

The currently available drugs cannot cure HBV, but are cheap, tolerant and effective in stopping the disease progression and reducing transmission. Studies have shown that early intervention can reduce the incidence of liver cancer by two-thirds or more.

Why are few people receiving treatment?

Many problems stem from outdated treatment thresholds. The current standards will cause too many people to wait until severe liver damage has occurred, researchers say.

“By delaying treatment, you put people at longer risk than necessary,” Tavis said. “And, you do too much damage to the liver before starting treatment.”

In addition to biology, the virus also brings emotional and social harm. In some areas, HBV positive persons face stigma, unemployment, or social exclusion. “Most mothers don’t know they’re infected,” Tavis added. “And the learning pressure you have on your baby’s fatal illness is unimaginable.”

Hope: RNA drugs aim to heal functions

While urgently improving the current treatment opportunities are urgent, another scientific aspect is rapidly developing: finding a cure. In another Scientific Translation Medicine In the article, the researchers detailed how RNA interference (RNAI) drugs can change the game. These drugs silence viral proteins, lower antigen levels and reactivate the body’s immune response.

“We’re very excited about some of these RNAi,” said Tavis, the lead author of the study. “They seem to have two modes of action, both inhibiting viral antigens and opening up the immune system.”

One such RNAi drug, Bepirovirsen, remains active several months after treatment, while also recruiting immune cells to help fight the virus. This two-pronged effect makes it a strong candidate for combination therapy.

Three-pronged treatment strategy

Now, researchers envision cocktail approaches similar to HBV in HIV or hepatitis C regimens. The ideal therapy will be combined:

• Replication inhibitors Stop viruses from reproduction
• RNAi drugs Reduce viral proteins and inhibit immune evasion
• Immunomodulator Improve the body’s natural defense ability

“If we do these three things together, we will eventually get rid of the virus,” Tavis said.

How close are we?

Encouragingly, early clinical trial results suggest that combination therapy can provide functional treatments – defined as elimination of viral DNA and surface antigens at least six months after treatment.

“In clinical trials, the best combination therapy is curable in about 30% after about one year to a half,” Tavis explained. “This is much better than a 5% standard of care.”

Although HBV DNA can permanently insert human genes, researchers hope that functional treatment will make recurrence less likely and significantly reduce the risk of liver cancer.

Call for policy changes and global visits

The gains from both groups of studies are obvious: existing treatments are effective and useless, while new treatments show real hope. Now, expanding access can save millions of lives, while researchers compete to invent treatments for day.

“These drugs are the shortcomings of good drugs,” Tavis said. “We need to adjust treatment paradigms for this disease.”

Published research

“Scientific and medical evidence to inform the extension of hepatitis C treatment guidelines”
Lancet Gastroenterology and Hepatology
doi: 10.1016/s2468-1253 (25) 00053-6
Publication date: July 23, 2025

“Patient and public health perspectives to inform the extension of HBV treatment guidelines”
Lancet Gastroenterology and Hepatology

“Functional treatment for chronic hepatitis B infection: mechanisms and treatment strategies”
Scientific Translation Medicine
Publication date: July 23, 2025

Related