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HCV update
Improving Equity in HCV Care Through Universal Screening and Treatment Simplification: Updates From EASL 2025

Released: June 12, 2025

Expiration: December 11, 2025

Stefan Zeuzem
Stefan Zeuzem, MD
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Key Takeaways
  • Streamlined, universal hepatitis C virus (HCV) testing is key for improving late or missed diagnoses.
  • Care coordination and “test and treat” strategies will be crucial for reaching vulnerable populations, including incarcerated people, and people experiencing homelessness.
  • Treatment simplification is key for improving disparities in HCV care and improving access to treatment.

The European Association for the Study of the Liver (EASL) 2025 presented innovative strategies for testing, treatment monitoring, and approaches to care. Read on to learn how I predict that these new data could affect hepatitis C virus (HCV) care in the near future.

Testing and Care Coordination
HCV infection is a curable disease, but diagnosis remains a significant issue and barrier to the WHO goal of eliminating it by 2030. Studies presented at EASL 2025 highlighted the importance of strategies to improve the rate and timeliness of diagnoses.

Other abstracts demonstrated the importance of reflex testing (HCV [polymerase chain reaction] RNA testing in serum samples with positive anti-HC antibodies). Systematic screening for HCV using reflex testing would enable early disease detection, and in my opinion, must become mandatory.

Finally, data presented from the Pro-Link HCV study in Spain demonstrated that testing HCV-RNA in serum samples of repositories in hospitals and central laboratories can be an innovative strategy for reengaging patients into care.

Innovations in HCV Care for Vulnerable Populations
Data on access to care and testing in special patient populations were also explored. HCV prevalence is high among incarcerated individuals, but access to treatment for incarcerated populations remains low, and patients who initiate treatment in prison are often lost to follow-up. Studies from EASL 2025 show that care-coordination strategies on transition from incarceration to community are needed, and improvements in testing and linkage to care in prisons is an essential step toward HCV elimination.

Of note, multiple abstracts demonstrated the effectiveness of “test and treat” strategies, particularly for vulnerable populations and those who experience barriers to treatment access, including incarcerated people and rural communities.

However, more novel strategies may be needed to reach other vulnerable people, such as those experiencing homelessness and those with mental health challenges. In particular, I think that expanding HCV care to be accessible in places where these people already engage in services­­—or meeting them where they are via health fairs or mobile clinics—is crucial for improving access to HCV care for these individuals.

HCV Care for Pregnant People and Pediatric Populations
Limited guidance exists for HCV treatment during pregnancy. However, I think that the available evidence shows that pregnant people should be tested for anti-HCV antibodies as part of routine screening when engaging in care. Although no safety concerns exist yet for antiviral therapy during pregnancy, treatment initiation should be carefully considered on an individual basis. On the one hand, vertical HCV transmission is rare; therefore antiviral therapy may be postponed until after delivery. On the other hand, many people with HCV infection are lost to follow-up after delivery.

Ultimately, although more guidance is needed regarding HCV treatment during pregnancy, universal screening for HCV among pregnant individuals is still important for detection of infection, and I believe that it may even improve screening rates in infants. As sustained virologic response (SVR) rates in pediatric patients are comparable to those in adults, early HCV infection diagnosis is highly beneficial for this population. Educating obstetricians and pediatricians is critical for HCV care engagement for these patients and for prevention of loss to follow-up.

Treatment Simplification
Despite HCV infection having a high rate of cure, treatment is still lengthy, and treatment simplification is still needed to streamline therapy. Studies have reported very few relapses between SVR4 and 12, suggesting that HCV RNA assessment at Week 4 of follow-up is sufficient to predict cure. Furthermore, as SVR rates are overall very high—even in patients with suboptimal adherence to therapy—posttreatment HCV-RNA testing for SVR (without interim monitoring) may be useful for assessing cure in certain subpopulations, such as people experiencing homelessness and people living in countries with very limited medical resources. In instances where cure is not achieved, retreatment (with a triple combination of antiretrovirals) was found to be highly efficacious. Fortunately, primary virologic nonresponse in the direct-acting antivirals era is nearly nonexistent.

Access to direct-acting antivirals may be limited in marginalized populations because of health disparities. To this end, the National Health Services HCV elimination program trial in England demonstrated that collective efforts (between government and public health agencies, people with lived experience, mobile outreach teams, addiction services, prisons, healthcare professionals, emergency departments, community pharmacies, and needle exchanges) showed considerable mortality benefits and improvements in healthcare equity.

Your Thoughts
Overall, data presented at EASL Congress 2025 emphasized the importance of universal HCV screening and improving access to care for achieving the 2030 WHO goal for HCV elimination. What do you think will be most important for achieving HCV elimination? Leave a comment below to join the discussion!