Within the development and approval of several new direct-acting
antivirals (DAA) against hepatitis C virus (HCV), a new era of
hepatitis C therapy has begun. Even more treatment options are likely to become available during the next 1-2 years.
METHODS: A summary of the current phase II and III trials investigating DAA and a review of the recent HCV guidelines was conducted.
RESULTS: With the development of new potent DAA and the approval of different DAA combinations, cure rates of HCV
infection of >90% are achievable for almost all HCV genotypes and stages of
liver disease. Currently available DAA target different steps in the HCV replication cycle, in particular the NS3/4A
protease, the NS5B polymerase, and the NS5A replication complex.
Treatment duration varies between 8 and 24 weeks depending on the stage of
fibrosis, prior treatment, HCV viral load, and HCV genotype.
Ribavirin is required only for some treatment regimens and may be particularly beneficial in patients with
cirrhosis. DAA resistance influences treatment outcome only marginally; thus, drug resistance testing is not routinely recommended before treatment. In the case of treatment failure, however, resistance testing should be performed before re-treatment with other DAA is initiated.
CONCLUSION: With the new, almost side effect-free DAA treatment options chronic HCV
infection became a curable disease. The clinical benefit of DAA combination
therapies in patients with advanced
cirrhosis and the effects on incidence rates of
hepatocellular carcinoma remain to be determined.