Recent Advances in the Treatment of Chronic Hepatitis C

A chronic hepatitis C virus (HCV) infection remains a major global health concern, with an estimated 50 million affected individuals. In South Korea, the prevalence of anti-HCV antibodies ranges from 0.6% to 0.8%, mainly in older adults. Untreated infections can progress to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. The introduction of direct-acting antivirals (DAAs) has transformed treatments, achieving sustained virologic response rates above 95% in most populations. Pan-genotypic regimens, including sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, provide simplified, short-duration, and highly effective therapy. Sofosbuvir/velpatasvir/voxilaprevir is reserved for patients with prior DAA treatment failure. The 2025 Korean Association for the Study of the Liver (KASL) guidelines emphasize streamlined treatment strategies and address management in special populations such as patients with decompensated cirrhosis, chronic kidney disease, HCC, HIV coinfection, and liver transplant recipients. Despite the excellent efficacy, clinical challenges remain in retreatment after DAA failure, in those with impaired hepatic reserve, and in vulnerable groups, including people who inject drugs and migrants. Furthermore, gaps in screening, diagnosis, and linkage to care continue to limit real-world impact. This review summarizes the current therapeutic updates for chronic hepatitis C, with a focus on pan-genotypic regimens, treatment duration, and strategies for special populations. Strengthening screening programs, optimizing retreatment, and expanding access are crucial for achieving the World Health Organization's goal of eliminating hepatitis C by 2030.