In April, the World Health Organization (WHO) released its first guidelines for the treatment of hepatitis C. With approximately 1.3-1.5 billion people infected with hepatitis C worldwide and 350,000-500,000 deaths per year from hepatitis C-related complications, some health policy experts consider the guidelines to be belated. For low- and middle-income countries, increasing treatment rates is not the first concern due to the many options available in the treatment of hepatitis C. Stefan Wiktor, M.D., WHO Global Hepatitis Program leader, believes that interferon-based regimens pose many problems for physicians, with high toxicity and unsatisfactory treatment response, making it difficult to promote their use in treatment. The new direct antiviral drugs sofosbuvir and simeprevir, the protease inhibitors boceprevir and telaprevir and a range of drugs in development have clearly increased confidence in the treatment of HCV infection. For patients infected with certain genotypes, the cure rate is now more than 90 percent. Wiktor said that we are making rapid progress and have very effective and safe drugs, and that the WHO is issuing timely guidelines to help countries build more strategies for the diagnosis and treatment of HCV and to plan the most feasible prevention and treatment interventions to reduce the epidemic. While the guidelines are primarily aimed at policy makers and physicians in low- and middle-income countries, they are also applicable to developed countries such as the United States. Yngve Falck-Ytter, co-chair of the WHO guideline publication group and associate professor of medicine at Case Western Reserve University and chief of the Division of Hepatology and Gastroenterology at the Cleveland VA Medical Center in Lewiston, said, “There are no other guidelines that include the new drugs simeprevir and sofosbuvir and are based on the rigorous WHO methodology. There are no other guidelines that include the new drugs simeprevir and sofosbuvir and are based on the rigorous WHO methodology. Although the WHO guidelines also make cost-benefit recommendations for HCV treatment, they still strongly recommend sofosbuvir for four of the six genotypes to avoid or reduce the use of interferon. The FDA approved sofosbuvir for marketing in December 2013, and in the United States, it is priced at $1,000 per tablet and costs $84,000 for a 12-week course. In Egypt, on the other hand, the total cost of sofosbuvir treatment is $900. wiktor believes that although still expensive, this 99% price tag still reflects the role of the government in negotiating with sofosbuvir manufacturer Gilead. A University of Liverpool study showed that a 12-week course of sofosbuvir costs only $68, so MSF advocates that the total cost of diagnosing and treating a patient with HCV with sofosbuvir should be $500. Both sofosbuvir and simeprevir are now available in India and are priced as reasonably as anti-HIV retroviral drugs, according to Rohit Malpani, head of policy and advocacy at MSF. First-line anti-HIV drugs have fallen from $10,000 20 years ago to just $200 per person per year. Malpani said that the case against Gilead’s sofosbuvir patent has been filed in India this year, and we think there is a good chance of winning, which would mean that developing countries would have a real opportunity to use sofosbuvir, but the government would also need to do something, either by demanding lower prices or by pushing through world trade regulations to reduce the cost of these drugs. For low- and middle-income countries, expensive drugs are not the only obstacle to treating HCV, and Wiktor believes that a major increase in HCV screening, laboratory diagnostic technology, and health care infrastructure is needed to make the guidelines really work. Organizations in these countries can use the guidelines to push for greater national attention to hepatitis prevention and treatment and related construction. Malpani also mentioned that governments should increase their investment in HCV treatment programs in the same way that they do for HIV. Unlike HIV, HCV is more common in middle-income countries, and funding from global and multiple sources is decreasing. The WHO guidelines provide nine key recommendations for screening for HCV infection in the population, mitigating liver damage in patients already infected, and providing appropriate treatment for those with chronic infection. The guidelines recommend that people in high-prevalence areas and at-risk populations be screened for HCV serology; that all HCV-infected individuals be assessed for alcohol intake and that moderate to heavy drinkers receive lifestyle interventions to reduce alcohol consumption; and that all adults and children with HCV infection, including those with intravenous addiction, receive antiviral therapy according to the guidelines. If resource constraints force priority treatment of some patients, those with progressive liver fibrosis and cirrhosis should be treated first, as they are more likely to progress to cirrhosis or even liver cancer. Falck-Ytter is optimistic about overcoming the difficulties in treating hepatitis C worldwide. He believes that there are already innovations and experience in treating chronic viral infections for HIV, and now it is just a matter of raising the profile of the disease burden in HCV countries and addressing the huge costs of the disease.