Cure of hepatitis C.

Since the discovery of the hepatitis C virus in 1989, many epidemiological data have been acquired, especially in Europe. Treatments have showed substantial improvement over the past 25 years and have taken a great leap forward with the development of the direct antiviral agents (DAAs). However, the burden of hepatitis C remains important in Europe with more than 5 million individuals living with HCV in the European Union. The peak of highest incidence occurred between 1970 and 1990 in most countries through transfusion, unsafe care and development of intravenous drug use. Transmission among intra-venous drug users is still an issue in most European countries, providing the majority of the new cases of HCV infection. Due to the chronic state of the viral infection and the usual slow progression of the liver disease, the peak of prevalence occurred around 2010, but the peak of complications, such as decompensated cirrhosis and hepatocellular carcinoma is still to come in most of the European countries.1 The risk of cirrhosis is usually estimated at 10 to 20% in 20 to 30 years of HCV infection evolution,2 higher in men than in women, but this risk increases in case of comorbidities such as excessive alcohol consumption, diabetes, obesity, HBV or HIV coinfection. The risk of decompensated cirrhosis can be estimated at 2 to 3% per year and that of hepatocellular carcinoma at 1 to 4% per year, also depending on the presence of comorbidities. In the next future, the challenge will be to identify infected people and treat with new effective treatments all patients at risk of developing complications, with the objective of decreasing the disease burden. Large discrepancies exist in Europe between countries in terms of knowledge of the disease burden, rate of infected people screened and access to treatment. All these factors play a major role on the expected evolution of the HCV epidemics. In countries where drug use has been the major risk factor of transmission, where screening and access to treatment are at a low level (e.g. England), the risk of decompensated cirrhosis, HCC and liver transplant will still increase in the coming years. By contrast, in countries where transfusions have played a large role in the diffusion of the epidemics, where screening and access to treatment