摘要
Over the past several years, more so recently, treatment options for hepatitis C virus(HCV) have seemed to exponentially grow. Up until recently, the regimen of pegylated interferon(peg-IFN) and ribavirin(RBV) stood as the standard of care. Direct acting antivirals, which target nonstructural proteins involved in replication and infection of HCV were first approved in 2011 as an addition to the peg-IFN and RBV regimen and with them have come increased sustained virological response rates(SVR). The previously reported 50%-70% SVR rates using the combination of peg-IFN and RBV are no longer the standard of care with direct acting antiviral(DAA) based regimens now achieving SVR of 70%-90%. PegIFN free as well as "all oral" regimens are also available. The current randomized controlled trials available show favorable SVRs in patients who are naive to treatment, non-cirrhotic, and not human immunodeficiency virus(HIV)-co-infected. What about patients who do not fit into these categories? In this review, we aim to discuss the currently approved and soon to be approved DAAs while focusing on their roles in patients that are treatment experienced, cirrhotic, or co-infected with HIV. In this discussion, review of the clinical trials leading to recent consensus guidelines as well as discussion of barriers to treatment will occur. A case will attempt will be made that social services, including financial support and drug/alcohol treatment, should be provided to all HCV infected patients to improve chances of cure and thus prevention of late stage sequela.
Over the past several years, more so recently, treatmentoptions for hepatitis C virus （HCV） have seemed toexponentially grow. Up until recently, the regimen ofpegylated interferon （peg-IFN） and ribavirin （RBV） stoodas the standard of care. Direct acting antivirals, whichtarget nonstructural proteins involved in replicationand infection of HCV were first approved in 2011 as anaddition to the peg-IFN and RBV regimen and with themhave come increased sustained virological response rates（SVR）. The previously reported 50%-70% SVR ratesusing the combination of peg-IFN and RBV are no longerthe standard of care with direct acting antiviral （DAA）based regimens now achieving SVR of 70%-90%. Peg-IFN free as well as ＂all oral＂ regimens are also available.The current randomized controlled trials available showfavorable SVRs in patients who are naive to treatment,non-cirrhotic, and not human immunodeficiency virus（HIV）-co-infected. What about patients who do notfit into these categories？ In this review, we aim todiscuss the currently approved and soon to be approvedDAAs while focusing on their roles in patients that aretreatment experienced, cirrhotic, or co-infected with HIV.In this discussion, review of the clinical trials leadingto recent consensus guidelines as well as discussion ofbarriers to treatment will occur. A case will attempt willbe made that social services, including financial supportand drug/alcohol treatment, should be provided to allHCV infected patients to improve chances of cure andthus prevention of late stage sequela.
