Elimination of hepatitis C in the Middle East: a narrative review of the efficacy of direct-acting antiviral therapies.

Background and objective: Hepatitis C virus (HCV), is a major health concern in the Middle East. Recent advances in direct-acting antivirals (DAAs) have transformed the treatment of HCV. The DAA chosen depends on the HCV genotype (GT) responsible for the infection, presence of cirrhosis, and prior treatment attempts. In addition, factors such as human immunodeficiency virus (HIV) co-infection and renal impairment can influence treatment. This literature review aims to discuss and appraise evidence on the efficacy and safety of the DAAs currently licensed for hepatitis C treatment in the Middle East.

Methods: Supporting publications from the National Institute for Health and Care Excellence (NICE) and European Association for the Study of the Liver guidelines were searched manually. A literature search of PubMed, MEDLINE, Cochrane Library, and EMBASE databases was performed with search terms including 'HCV', 'clinical trial', and the seven combinations of DAA combinations recommended by NICE. Papers from January 2016 to January 2021 were considered, along with seminal papers outside this range.

Key content and findings: Of 390 publications found, 62 were included. In most studies, DAAs showed high efficacy in the recommended GTs, cirrhosis states, and prior HCV treatments. DAAs were found to be generally safe and well-tolerated: the most common side effects throughout were headache and nausea. Serious adverse events (SAEs) were seen when ribavirin and peginterferon alfa were taken in combination with the DAA.

Conclusions: This review demonstrates the strong evidence for the efficacy and safety of DAAs. The focus of HCV research should shift from efficacy of treatment to investigating accessible screening and diagnostics in order to achieve the World Health Organisation's (WHO's) goal of eradicating HCV by 2030.