COMMENTARY
HCV Treatment: What Can I Do Now? What's Coming Next?
Rowen K. Zetterman, MD
Treating an Underdiagnosed Disease
Approximately 170-200 million persons worldwide are infected with hepatitis C virus (HCV), including 3.2 million in the United States.[1] Many lack symptoms and are clinically unrecognized.[2]
Outcomes of HCV infection include chronic hepatitis; cirrhosis; hepatocellular carcinoma; and a need for orthotopic liver transplantation owing to complications, such as cirrhosis or cancer.[3] Estimating the quantity of fibrosis in a liver biopsy specimen from patients with HCV may help determine the risk for decompensation[4] and the need for HCV therapy. Approximately 40% of patients awaiting liver transplantation have underlying HCV infection, and recurrent HCV infection of the transplant allograft is virtually assured.[5] Eradication of HCV from infected patients improves survival of all patients, even if they have advanced liver disease.[6,7]
There are six major genotypes of HCV.[8] Genotype 1 accounts for approximately 75% of HCV infections in the United States, of which two thirds are genotype 1a and one third are genotype 1b. Genotype 1b is less likely to develop resistance during therapy, resulting in better cure rates with treatment than genotype 1a. Approximately 16% of HCV-infected patients have genotype 2; 12% have genotype 3; and 1% each have genotype 4, 5, and 6.
The development of direct-acting antivirals represents a significant improvement in HCV treatment. New combinations of drugs have led to improved response rates, even in patients with characteristics previously associated with having lower response rates: African American, high viral load, concomitant cirrhosis, infection with genotype 1a, and failed treatment with other anti-HCV drugs.[9]
Continue reading @ Medscape
Surveying the Current Treatment Landscape
Emerging Drugs
Options for Difficult-to-Treat Patients
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