Published online Jan 28, 2016. doi: 10.4254/wjh.v8.i3.139
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
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.
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.