Treatment of hepatitis C

Abstract

Chronic hepatitis C virus (HCV) infection is the major cause of liver cirrhosis, hepatocellular carcinoma and liver transplantation in the western world. The development and approval of nine directly acting antiviral drugs in recent years has led to a dramatic improvement in therapeutic efficacy accompanied by fewer side effects. With current treatment options sustained virologic response in more than 90 % of patients can be achieved depending on HCV genotype, liver cirrhosis and prior therapies. Modern HCV treatment regimens are interferon-free and should be administered for 12-24weeks. Shorter courses are possible in selected patients. For the treatment of HCV genotype1 infection combinations of either the nucleotide polymerase inhibitor sofosbuvir with the protease inhibitor simeprevir or with one of the two NS5A inhibitors daclatasvir or ledipasvir on the one hand or triple DAA therapy of paritaprevir, ombitasvir and dasabuvir on the other hand are applicable. Ribavirin has still a role as an add-on in difficult to treat patients.