The approval of directly acting
antivirals (DAA) for the treatment of
chronic hepatitis C virus (HCV)
infection will represent a major breakthrough for the 180 million persons infected worldwide. Paradoxically,
hepatitis C is the only human chronic
viral disease that can be cured, as all other pathogenic viruses infecting humans either display self-limited courses or establish non-eradicable
persistent infections. Until now, treatment of
chronic hepatitis C consisted of the combination of peginterferon-α plus
ribavirin, which provided limited rates of cure and was associated with frequent side effects. Several DAA have been identified that inhibit the NS3
protease, the NS5B polymerase or the NS5A replication complex, and have entered the final steps of clinical development. These molecules, coupled with significant progress made in the recognition of more potent and safe
interferon forms (e.g.
interferon-λ) and host
protein targets (e.g.
alisporivir), are opening a new era in
hepatitis C therapeutics. The expectations are so great that, to some extent, it is reminiscent of what happened in 1996 in the HIV field when the introduction of the first
protease inhibitors as part of triple combinations revolutionized antiretroviral
therapy. To maximize treatment success and reduce the likelihood of drug resistance selection, a proper individualization of
hepatitis C therapy will be required, choosing the most convenient drugs and strategies according to distinct viral and host profiles. The complexity of HCV
therapeutics has reached a point that presumably will lead to the birth of a new specialist, the HCV doctor.