Millions of Americans are still battling potentially deadly hepatitis C, even though it can be cured without antiviral drugs, a new analysis finds.
Dr. Sanjay Kishore, a researcher at the University of Virginia School of Medicine, and colleagues at the Massachusetts General Brigham looked at prescribing trends for the drug, known as a direct-acting antiviral. They found that prescriptions rose rapidly in 2013, when the drug was first introduced, and peaked in 2015. After that, usage began to decline, and has declined sharply in recent years.
Researchers warn that this alarming trend threatens both the health of many Americans and the federal government’s goal of eliminating the disease in the United States.
Hepatitis C is a deadly disease that affects tens of thousands of people right here in Virginia. Medicines can cure hepatitis C, but they can only work miracles by getting them to the sick. ”
Dr. Sanjay Kishore, internist at UVA Health
prevent hepatitis C
Hepatitis C is a blood-borne virus that damages the liver. In the United States, it is most commonly transmitted through drug use, but it can also be passed from mother to child at birth and, less commonly, through sexual intercourse. Many people do not know they have the virus because symptoms such as jaundice (yellowing of the skin and eyes), fatigue, fever, and nausea do not appear until serious liver damage occurs. It is estimated that up to 4 million Americans are chronically infected with hepatitis C.
Direct-acting antivirals are a major advance in the treatment of hepatitis C and can cure more than 95% of patients. However, despite the availability of drugs, the number of new infections remains high. This led Kishore and his colleagues to investigate whether the drugs were getting to the people who needed them.
Researchers found that more than 185,000 courses of the drug were administered to patients in 2015. However, that number fell below 70,000 courses by 2025.
The initial surge in antiviral treatment was concentrated among the elderly and patients with Medicare or commercial insurance, researchers report. In the early days of the drug’s availability, Medicaid restricted prescribing to patients with advanced liver scarring, but use among this group increased steadily from 2016 to 2019 and then declined, likely due to access issues caused by the COVID-19 pandemic.
“Treatment levels that are too low may help explain why the prevalence of hepatitis C has not declined in recent years and may even have increased,” said lead author Benjamin Rome, MD, MPH, of the Department of Pharmacoepidemiology and Pharmacoeconomics, Massachusetts General Brigham Medical School. “Eliminating it will require system-level changes, not just better screening.”
Experts estimate that about 260,000 treatment courses will need to be administered each year to reach the country’s goal of eliminating the virus. In addition to ramping up testing, researchers are calling for immediate action, including increasing same-day treatment, expanding telemedicine and mobile outreach, and funding reforms like those proposed in the Hepatitis C Treatment Act of 2025.
“We don’t have to wait for Congress,” said Kishore, a former medical resident at Brigham and Women’s Hospital. “If we work together to get these medicines to the most vulnerable people, Virginia could become the first state in the country to eliminate hepatitis C.”
Publication of survey results
The researchers published their analysis in the prestigious Journal of the American Medical Association. The research team consisted of Kishore, Margaret Hayden, Micah Johnson, Aaron S. Kesselheim, and Roma.
This research was supported by a grant from Arnold Venture.
Mr. Kishore and Mr. Hayden discussed the Equal Justice Initiative. Kishore, Hayden and Johnson are also unpaid co-founders of EqualCure, an organization promoting treatment for hepatitis C. A complete list of author disclosures is included in the paper.
sauce:
University of Virginia Health System
Reference magazines:
Kishore, S. others. (2026). National prescription trends for direct-acting antiviral drugs for hepatitis C Japan Automobile Manufacturers Association. DOI: 10.1001/jama.2026.3328. https://jamanetwork.com/journals/jama/article-abstract/2846850
