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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 28, 2016; 8(3): 139-147
Published online Jan 28, 2016. doi: 10.4254/wjh.v8.i3.139
Advances in hepatitis C therapy: What is the current state - what come’s next?
Steffen Zopf, Andreas E Kremer, Markus F Neurath, Juergen Siebler
Steffen Zopf, Andreas E Kremer, Markus F Neurath, Juergen Siebler, Medical Department 1, University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Author contributions: Zopf S, Kremer AE, Neurath MF and Siebler J made substantial contributions to conception and design of the manuscript; Zopf S and Kremer AE wrote the paper; Neurath MF and Siebler J critically revised the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Steffen Zopf, MD, Medical Department 1, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany. steffen.zopf@uk-erlangen.de
Telephone: +49-9131-8535000 Fax: +49-9131-8535207
Received: April 29, 2015
Peer-review started: May 8, 2015
First decision: September 8, 2015
Revised: December 15, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: January 28, 2016
Abstract

Chronic hepatitis C virus (HCV) infection affects 80-160 million people worldwide and is one of the leading causes of chronic liver disease. It is only a few years ago that standard treatment regimes were based on pegylated interferon alpha and ribavirin. However, treatment of HCV has undergone a revolutionary change in recent years. The admission of the nucleotide polymerase inhibitor Sofosbuvir enabled an interferon-free regimen with direct antiviral agents (DAA). Meanwhile seven DAAs are available and can be applied in several combinations for 8 to 24 wk depending on HCV genotype and patient characteristics such as cirrhosis and chronic renal failure. High rates of sustained virological response (SVR) rates can be achieved with these novel drugs. Even in difficult to treat populations such as patients with liver cirrhosis, HCV-human immunodeficiency virus co-infections, after liver transplantion, or with chronic kidney disease comparable high rates of SVR can be achieved. The anticipated 2nd generation DAAs are strikingly effective in patients so far classified as difficult to treat including decompensated liver cirrhosis or post-transplant patients. These 2nd generations DAAs will have higher resistance barriers, higher antiviral effects and a pan-genotypic spectrum. This review highlights the current state of the art of antiviral treatment in hepatitis C and gives an outlook for upcoming therapies.

Keywords: Hepatitis C virus, Direct antiviral agents, Sustained virological response, Liver transplantation, Renal impairment, Cirrhosis

Core tip: Treatment of chronic hepatitis C virus (HCV) infections has undergone a revolutionary change in recent years. This review highlights the current state of the art of antiviral treatment in chronic hepatitis C infections and gives an outlook for upcoming therapies. Difficult to treat populations such as patients with decompensated liver cirrhosis, HCV-human immunodeficiency virus co-infections, after liver transplantation and patients with renal impairment or on hemodialysis are highlighted.