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Millions of Americans are still battling potentially deadly hepatitis C even though they could be cured with antiviral drugs they are not receiving, a new analysis reveals.

UVA School of Medicine researcher Sanjay Kishore, MD, and colleagues at Mass General Brigham looked at prescribing trends for the drugs known as direct-acting antivirals. They found prescriptions rose rapidly when the drugs were first introduced in 2013, then peaked in 2015. After that, use began to decline and has fallen sharply in recent years. 

The researchers are warning that the alarming trend threatens many Americans’ health and federal goals to eliminate the disease in the United States.

“Hepatitis C is a deadly disease that affects tens of thousands of people right here in Virginia,” says Dr. Kishore, Internal Medicine, UVA Health. “While medicines can cure hepatitis C, they can only work their miracles if we deliver them to those who are ill.” 

Stopping Hepatitis C

Hepatitis C is a bloodborne virus that damages the liver. It’s most often spread in the United States through drug use, though it can also spread from a mother to her child during birth and, less commonly, through sexual activity. Many people are unaware they have the virus because symptoms such as jaundice (yellowing of the skin and eyes), fatigue, fever, and nausea don’t appear until significant liver damage has occurred. It’s estimated that up to 4 million Americans have chronic hepatitis C infections. 

Direct-acting antivirals represented a huge step forward in the treatment of hep C. They can cure more than 95% of patients. Despite the availability of the drugs, however, the number of new cases has remained stubbornly high. That prompted Kishore and his colleagues to look into whether the drugs are getting to the people that need them.

The researchers found more than 185,000 courses of the drugs were administered to patients in 2015. But that number had plunged below 70,000 for 2025.

The initial burst in antiviral treatment was concentrated in older adults and patients with Medicare or commercial insurance, the researchers report. In the early days of the drugs’ availability, Medicaid restricted prescriptions to patients with advanced liver scarring, but use among this group increased steadily between 2016 and 2019 before dropping off, possibly because of access issue caused by the COVID-19 pandemic.

“Treatment levels being too low may help explain why hepatitis C prevalence hasn’t fallen, and may have even increased, in recent years,” says senior author Benjamin Rome, MD, MPH, Division of Pharmacoepidemiology and Pharmacoeconomics at Mass General Brigham Department of Medicine. “Elimination will require system-level changes, not just better screening.”

Experts estimate that roughly 260,000 treatment courses need to be administered each year to meet the national target to eliminate the virus. In addition to increased screening, researchers are urging swift actions such as facilitating same-day treatment, expanding telehealth and mobile outreach, and financing reforms such as proposed in the Cure Hepatitis C Act of 2025.

“We don’t have to wait for Congress,” says Dr. Kishore, former resident at Brigham and Women’s Hospital. “Virginia could be the first state in the country to eliminate hepatitis C if we commit together to deliver these drugs to the most vulnerable.”  

Findings Published

The researchers have published their analysis in the prestigious Journal of the American Medical Association. The research team consisted of Dr. Kishore, Dr. Rome, Margaret Hayden, Micah Johnson, and Aaron S. Kesselheim.

The research was supported by a grant from Arnold Venture.

Dr. Kishore and Hayden have consulted for the Equal Justice Initiative. Kishore, Hayden and Johnson also are unpaid cofounders of EqualCure, a group that facilitates hepatitis C treatment. A full list of the authors’ disclosures is included in the paper.

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