New Therapies for Hepatitis C Virus Infection

Abstract

Approximately 350 million people worldwide are infected with hepatitis C virus (HCV), which is associated with morbidity and mortality related to cirrhosis, hepatocellular carcinoma, or liver failure. Recently, vast improvements have been made with the development of direct-acting antiviral (DAA) agents, which are all-oral, are better tolerated than interferon-based treatment, and provide a sustained virologic response in more than 90% of treated patients. This article reviews the new therapies available for HCV infection, with a focus on patients who have chronic HCV with and without compensated cirrhosis. As DAA development continues, more attention will need to be given to special patient populations, specifically to patients who fail treatment due to emerging resistant strains. Considerable challenges yet to be overcome are incremental diagnosis of unidentified patients and linkage to care that is affordable and available to all patients.

Treatment-Naive, Cirrhotic Patients

In cirrhotic patients, the newly approved sofosbuvir/velpatasvir regimen is highly effective with SVR rates of 98% to 99% after 12 weeks of treatment.19,39 Sofosbuvir/ledipasvir for 12 weeks (coadministered with ribavirin in patients with decompensated cirrhosis) and the elbasvir/grazoprevir regimen should be used with caution in patients with preexistent RAVs.24,30,40

While approved for use in compensated cirrhotic patients, paritaprevir/ritonavir/ombitasvir and dasabuvir should be used with caution if there is any sign of decompensation, as the FDA has issued a warning of hepatic decompensation and liver failure in rare cases with this regimen.41 In patients with HCV genotype 1a infection, the duration of this regimen is increased from 12 weeks to 24 weeks.

Dr.Om Vathanak

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