Hepatitis C Therapy: Lessons of the Last Two Decades

Abstract

Many important therapeutic lessons have been learned since the discovery of hepatitis C virus (HCV) in 1989. A sustained virological response (SVR) is now recognized to be considered tantamount to a cure and is the goal of therapy for chronic hepatitis C (CHC). Prior to the development of directly-acting antiviral therapies (DAA), SVR rates of between 50 % and 80 % were achievable using the previous standard of care for CHC, pegylated interferon and ribavirin. The mechanisms behind the inter-individual variation in response to interferon-based therapy had been elucidated by recent genome-wide association studies. The introduction of DAA therapy has resulted in a significant increase in SVR rate and given hope to patients with CHC in whom interferon is ineffective or contraindicated. The development of a therapeutic vaccine for HCV is, however, still in its infancy. This article will review the triumphs and tribulations of HCV therapy that have been witnessed over the last two decades.