Addressing The Gap Between Cure and Access in HCV Care, with Paulina Deming, PharmD

Once considered a daunting, chronic illness with limited treatment options, hepatitis C virus (HCV) infection is now curable in the vast majority of patients—typically with a short course of well-tolerated antiviral therapy. Despite this clinical triumph, the global goal of eliminating HCV as a public health threat by 2030 is quickly slipping out of reach.

On this World Hepatitis Day, it’s a sobering reality that while treatment access has expanded and cure rates remain high, the number of new infections continues to rise—driven in large part by injection drug use and systemic failures in harm reduction, screening, and linkage to care. With these trends outpacing the current response, there is an urgent need to re-evaluate how we approach HCV elimination.

To better understand the current challenges and opportunities in the fight against hepatitis C, the editorial team of HCPLive Hepatology spoke with Paulina Deming, PharmD, assistant director of Viral Hepatitis Programs and an associate professor of pharmacy practice and administrative sciences at The University of New Mexico, about the drivers of new infections, the systemic barriers that continue to impede progress, and the changes she believes are most urgently needed to get elimination efforts back on track in the following Q&A:

HCPLive Hepatology: Acknowledging that we are not on track to hit the goals that we set for eradication by 2030, what does it look like in the world of hepatitis C right now, and where would you like to see us relative to where we thought we would be as we sit 5 years out from this goal?

Deming: I think the challenge we're running into is that although there is an increase in the treatments, or the number of patients getting treated for hepatitis C, the number of people with new infections continues to rise. So unfortunately, we are being outpaced by new infections. So we'd like to really see the ability to get more people on treatment and get them the whole course of therapy so that they can go ahead and finish it up and get cured of hepatitis C. I think that's really the main issue that we're encountering here in particular.

HCPLive Hepatology: What do you think are the main drivers of these new cases?

Deming: I think that's a very difficult question. There's definitely still lots of injection drug use going around. I think access to syringe exchange programs and support is essential. I also think allowing patients to get a whole course of therapy is critical. There are sometimes unexpected barriers.

People may want to get hepatitis C treatment [even though] they don't necessarily feel sick because they are early on in their infection, but they are wanting the treatment, but then run into barriers such as being unable to get the course of therapy. Whether it's the need to get labs and then more labs and then follow-up labs and sort of barriers that are systemic that don't need to be there.

The reality is, treatment is so easy now that for the vast majority of patients, they could just get the whole treatment course and [we could] trust them to go ahead and complete it. I think a lot of people could do that. But again, they run into these barriers, whether it's the initial laboratory requirements that are put upon them, or the need to follow up, or even to be contacted in order to get their first fill, and then subsequently, if they need to get refills, there's barriers there so that they can't get the whole course of therapy. So I think that's a challenge for people, and it's unnecessary, and I think it causes people to become frustrated. So despite all intentions to get therapy with competing interests going on in their lives, sometimes they're unable to finish that treatment course and unfortunately, they don't get the cure.

HCPLive Hepatology: Looking at the landscape for HCV in general, if you had to prioritize one system level change now, what would you like to see between now and World Hepatitis Day 2026?

Deming: I would love if we could just get people the full course of therapy, whether it's the full 8 weeks or full 12 weeks. To be able to hand [it to] them at their first visit when they're told they have hepatitis C and say “Here's your treatment course. Please take your meds. Do your best to complete the therapy.” I think that would make a big impact.

HCPLive Hepatology: If you could have one call to action for your colleagues across the broader healthcare community, what would it be?

Deming: I would say in general, hepatitis C treatment really has come a long way, but there's still a lot of concerns about the medications and concerns about whether the patients will take them or not. I would encourage clinicians to trust that the patients will take their medications, give them the whole course of therapy, let them participate more in their health and allow them to get those cures. So I think again, more screening, more testing, and really encouraging people to get on treatment and trusting that these meds will do their job.

Editors' note: Deming reports relevant disclosures with Gilead Sciences.

Reference

World Health Organization. Hepatitis. Accessed July 28, 2025. https://www.who.int/health-topics/hepatitis/elimination-of-hepatitis-by-2030#tab=tab_1