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Update on Current Evidence for Hepatitis C Therapeutic Options in HCV Mono-infected Patients

  • Intra-abdominal Infections, Hepatitis, and Gastroenteritis (T Steiner, Section Editor)
  • Published:
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Abstract

Purpose of Review

Therapies for hepatitis C (HCV) are evolving rapidly with the advent of novel direct-acting antiviral agents (DAAs). We review evidence for currently or imminently available regimens to aide clinicians in understanding current therapeutic options.

Recent Findings

A number of DAA combinations have completed clinical trials and are available for use. Current combinations are often genotype-specific, and combine HCV protease inhibitors, NS5A inhibitors and/or NS5B inhibitors to suppress HCV replication, leading to eradication. Current potential combinations for genotype 1 infection include sofosbuvir-ledipasvir, paritaprevir/ritonavir-ombitasvir-dasabuvir, sofosbuvir with daclatasvir, and grazoprevir-elbasvir. These regimens have been associated with sustained virologic response (SVR) rates of over 95 % for treatment naïve individuals after 12 weeks of therapy regardless of cirrhosis, and some sub-groups of patients may be successfully treated with just 8 weeks of sofosbuvir-ledipasvir. Regimens for genotype 2 and 3 include sofosbuvir with ribavirin, sofosbuvir with daclatasvir, or with velpatasvir, which may offer highest SVR rates when available. The development of HCV drug resistance, particularly against NS5A agents, may impact subsequent regimens. The need for baseline screening for resistant variants is unclear for most regimens, but likely would affect only a minority of patients.

Summary

All-oral curative regimens for HCV are now possible for most patients.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of AIDS, Faculty of Medicine, University of British Columbia, Room 667 1081 Burrard St, Vancouver, V6Z 1Y6, Canada

    Mark W. Hull, Eric M. Yoshida & Julio S. G. Montaner

  2. BC Centre for Excellence in HIV/AIDS, Vancouver, Canada

    Mark W. Hull & Julio S. G. Montaner

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  1. Mark W. Hull
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  2. Eric M. Yoshida
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  3. Julio S. G. Montaner
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Correspondence to Julio S. G. Montaner.

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Conflict of Interest

Dr. Mark Hull has received grant support from the National Institute on Drug Abuse (NIDA R01DA031043-01) and is an investigator of clinical trials sponsored by Abbvie Inc, BMS, Gilead. He has received honoraria paid to his institution for CME lectures/attendance at Advisory boards from Abbvie, BMS, Gilead, Merck, Ortho-Janssen.

Dr. Eric Yoshida is an investigator of clinical trials sponsored by Gilead Inc, Merck Inc, Vertex Inc, Hoffman LaRoche Inc, Abbvie Inc, Janssen Inc, Boeringher Ingelheim Inc. He has received honoraria for CME lectures from Merck Canada, Gilead Canada. He has been a speaker at Advisory Board Meetings of Boeringher Ingelheim Canada, Hoffman LaRoche Canada, Abbvie Canada for which he received an honorarium. He is a member of the Gilead Canada compassionate release program adjudication committee for which he has received an honorarium.

Dr. Julio Montaner has received research support from the BC Ministry of Health, US NIH (NIDA R01DA036307), UNAIDS, ANRS, and MAC AIDS Fund. Institutional grants have been provided by Abbvie, BMS, Gilead Sciences, J&J, Merck, and ViiV Health. He has served on Advisory Boards for Teva, Gilead Sciences, and InnaVirVax.

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This article does not contain any studies with human or animal subjects performed by the author.

Additional information

This article is part of the Topical Collection on Intra-abdominal Infections, Hepatitis, and Gastroenteritis

Key Points

• Direct acting antivirals (DAA’s) are now first-line therapy for HCV.

• SVR12 rates for genotype 1, treatment-naïve patients are at least 95 % in the clinical trial setting.

• Presence of cirrhosis may affect the regimen type (by requiring additional ribavirin for some regimens) or treatment length.

• Genotype 3 infection respond less well to current DAA’s, and use of combination therapy with sofosbuvir/pegylated interferon and ribavirin may achieve highest SVR12 rates for cirrhotic treatment-experienced patients.

• Consideration of drug interactions is critical when selecting DAA regimens.

• Development of HCV drug resistance can be seen in certain individuals failing therapy, and the role for baseline screening for resistance associated variants is not yet clear.

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Hull, M.W., Yoshida, E.M. & Montaner, J.S.G. Update on Current Evidence for Hepatitis C Therapeutic Options in HCV Mono-infected Patients. Curr Infect Dis Rep 18, 22 (2016). https://doi.org/10.1007/s11908-016-0527-8

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  • DOI: https://doi.org/10.1007/s11908-016-0527-8

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