Hepatitis C treatment: where are we now?

Nicholas J Burstow,¹ Zameer Mohamed,¹ Asmaa I Gomaa,² Mark W Sonderup,³ Nicola A Cook,¹ Imam Waked,² C Wendy Spearman,³ Simon D Taylor-Robinson<sup>1

1</sup>Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK; ²National Liver Institute, Menoufiya University, Shbeen El Kom, Egypt; ³Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa

Abstract: Chronic hepatitis C infection affects millions of people worldwide and confers significant morbidity and mortality. Effective treatment is needed to prevent disease progression and associated complications. Previous treatment options were limited to interferon and ribavirin (RBV) regimens, which gave low cure rates and were associated with unpleasant side effects. The era of direct-acting antiviral (DAA) therapies began with the development of first-generation NS3/4A protease inhibitors in 2011. They vastly improved outcomes for patients, particularly those with genotype 1 infection, the most prevalent genotype globally. Since then, a multitude of DAAs have been licensed for use, and outcomes for patients have improved further, with fewer side effects and cure rates approaching 100%. Recent regimens are interferon-free, and in many cases, RBV-free, and involve a combination of DAA agents. This review summarizes the treatment options currently available and discusses potential barriers that may delay the global eradication of hepatitis C.

Keywords: hepatitis C, protease inhibitors, directly acting antivirals, interferon-free regimens, ribavirin-free regimens, hepatitis C eradication