Hepatitis C: innovations in therapeutic interventions and elimination strategies

INTRODUCTION: Hepatitis C virus (HCV) affects approximately 47 million people worldwide and remains a major cause of chronic liver disease and liver-related mortality. Although direct-acting antiviral (DAA) therapy has transformed HCV into a highly curable infection, persistent gaps in diagnosis, linkage to care, harm reduction coverage, and health-system capacity impede progress toward World Health Organization (WHO) 2030 elimination targets. AREAS COVERED: This review summarizes advances in HCV therapeutics, including pangenotypic DAA regimens, shortened treatment strategies, and emerging antiviral agents, and examines treatment in special populations, including decompensated cirrhosis, acute HCV, transplant recipients, children, people who inject drugs, and pregnant women. It also explores diagnostic innovations and implementation strategies to accelerate elimination, including point-of-care HCV RNA testing, reflex testing, decentralized care, and microelimination frameworks. PubMed, Embase, and Google Scholar were searched from inception to March 2026. EXPERT OPINION: Modern DAA regimens cure over 95% across most populations, but eliminating HCV as a public health threat will require prioritizing underserved populations, simplified diagnostic pathways, equitable access to treatment and retreatment, and investment in harm reduction. Antenatal DAA therapy, ultra-short regimens, and long-acting antivirals represent the next frontier, though elimination will depend on implementation science as much as pharmacological innovation.