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Management of Direct-Acting Antiviral Failures in Chronic Hepatitis C Infection

  • Hepatitis C (J Ahn, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of review

Direct-acting antiviral agents have revolutionized the treatment for chronic hepatitis C infection with very high cure rates. Treatment failures are commonly due to non-adherence and relapse but less often to viral breakthrough while on therapy. Resistance-associated variants have also emerged to be a culprit for treatment failures. Optimal retreatment regimens in patients who fail direct-acting antiviral agents have been unclear due to limited data.

Recent Findings

In vitro and in vivo studies have suggested that hepatitis C drug-resistant variants undermine direct-acting antiviral-based therapy in patients who do not achieve viral eradication. The risk of developing these variants depends on host- and virus-related factors, the properties of the drugs used, and the treatment strategies applied. The most effective methods in preventing the development of resistant variants include using potent antiviral combinations with high barriers to resistance and reinforcing patient compliance with treatment.

Summary

Despite the effectiveness of direct-acting antiviral agents, patients may fail to attain sustained virologic response and salvage therapy may need to be considered. Therapeutic options are limited and more research needs to be directed towards this select group of patients.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA

    Kevin Tin & Eiei Soe

  2. Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, 530 First Ave, HCC-4J, New York, NY, 10016, USA

    James Park

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Correspondence to James Park.

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Dr. Kevin Tin and Dr. Eiei Soe declare that they have no conflicts of interest. Dr. James Park is a speaker and consultant for Bristol Myers Squibb, Gilead, Abbvie, and Merck.

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Tin, K., Soe, E. & Park, J. Management of Direct-Acting Antiviral Failures in Chronic Hepatitis C Infection. Curr Hepatology Rep 15, 296–306 (2016). https://doi.org/10.1007/s11901-016-0326-6

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