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Antiviral therapy with direct-acting antiviral (DAA) for patients infected by hepatitis C virus (HCV) has made a remarkable progress, enabling more patients eligible for treatment compared to interferon era. Indeed, DAA treatment with high efficacy and safety is an important major component of global strategy to eliminate HCV infection until 2030, proposed by the World Health Organization (WHO). The epidemiological and clinical characteristics related to HCV infection largely differ among regions and countries. Even in a region or country, these characteristics might be different between two time periods which are divided by introduction of DAA. Thus, it is relevant to figure out which characteristics are clinically significant in post-DAA period compared with pre-DAA period to help implement an effective program for HCV elimination. In this issue, Nam et al. investigated the changing epidemiological and clinical characteristics of HCV infection in South Korea between 2007 and 2017. A total of 2,758 patients with HCV viremia were prospectively enrolled at seven tertiary hospitals. Apart from various data collected from medical records, a survey was conducted using patient questionnaire to reveal risk factors for HCV infection. The overall characteristics of patients including mean age, disease severity ranging from chronic hepatitis, cirrhosis to hepatocellular carcinoma (HCC) and HCV genotypes were not much different from those previously reported. The major risk factors associated with HCV infection in South Korea were known to be multiple sexual partners, tattooing, history of transfusion, acupuncture and needle stick injuries. This article also confirms that multiple factors such as tattooing, piercing, blood transfusion and needle stick injuries contribute to HCV infection in South Korea. There was an epidemiological difference between males and females, showing a higher frequencies of intravenous drug use experiences, needle stick injuries and multiple sexual partners in males. Whereas such risk factors as history of transfusion, tattooing, piercing and acupuncture were more closely related to HCV infection in females, suggesting different risk factors by gender depend on the behavioral characteristics and degree of risk exposure. Several clinical characteristics differed between pre-DAA (2007 to 2014) and post-DAA (2015 to 2017) period. The mean age of patients recently enrolled (post-DAA period) was higher than those enrolled at pre-DAA period (60.6 years vs 56.15 years, p<0.001). Compared to pre-DAA period, there were more male patients, less patients with education above high-school level, more patients with HCC or cardiovascular disease in postDAA period. This observation might be partly explained by older age of patients in recent period. Since introduction of DAA in early 2000, treatment paradigm of HCV infection has been rapidly and dramatically evolved. A higher sustained virological response (SVR) rates, shorter treatment duration, better safety and tolerability resulted in higher treatment uptake rates at least in a special patient population. In a modeling study, combination of higher SVR rates, improved HCV diagnosis and higher treatment uptake rates was found to achieve HCV elimination until 2030 in South Korea. Then, are treatment uptake rates actually increasing in Korea? In this article, the overall treatment uptake rates were 52.8% and 56.1% in pre-DAA and post-DAA period, respectively. The reasons why there is not apparent increase in the treatment uptake rates

Awareness and Access to Therapy in Hepatitis C Virus Infected Patients, Key Barriers to Eliminate the Virus?