Treatment of Hepatitis C: State of the Art 2018

Abstract

Aim of antiviral therapy on an individual patient level is a sustained virologic response, on a population level the elimination of the hepatitis C virus (HCV). The latter is an aim also defined by the WHO. Specific inhibitors of the RNA-dependent RNA-polymerase, the NS3/4A protease, and the NS5A protein as well as ribavirin are available for antiviral therapy of HCV. Typically, two direct antiviral agents are combined, the treatment duration for the majority of patients is between 8 and 12 weeks. Potential drug-drug interactions with patients' basic medications must be assessed. Two pangenotypic regimens are available: sofosbuvir/velpatasvir and glecaprevir/pibrentasvir. In the individual decision between regimens hepatic and renal function as well as drug-drug interactions must be considered. The sustained virologic response rates are above 95 %, safety and tolerability of the treatment regimens are excellent. In patients with decompensated cirrhosis treatment with protease inhibitors is contraindicated. Sofosbuvir is not approved in patients with severe renal insufficiency. Patients who failed an interferon-free therapy should be retreated with sofosbuvir/velpatasvir/voxilaprevir.