Tuesday, November 20, 2018

The Revolution in Treatment of Hepatitis C

Medical Clinics
January 2019 Volume 103, Issue 1, Pages 43–55 

The Revolution in Treatment of Hepatitis C
•Hepatitis C infection typically goes unrecognized at onset and develops into a chronic infection that can lead to cirrhosis, liver failure and liver cancer.
•Novel treatments that are safe, without significant side effects and nearly 100% effective became available in the last 5 years.
•Sustained viral response (SVR--no virus detectable 12 weeks after end of treatment) is synonymous with life-long cure.
•SVR patients with cirrhosis require ongoing surveillance for liver cancer.
•Remaining challenges include identifying those who are not aware but have infection and providing treatment for those lacking funding.

Article Outline
Key points
Risk factors for hepatitis C
Natural history
Acute hepatitis C
Chronic hepatitis C
Pretreatment testing
Current treatment options for hepatitis C
Eight-week treatment options
Hepatitis B screening
Special patient populations
Renal disease
Decompensated liver disease
Post-treatment laboratory studies and follow-up
Barriers to treatment

Treatment of hepatitis C with interferon therapy produced some cures early on, but was associated with significant side effects. Because of further advances in the molecular understanding of hepatitis C, by 2014 effective treatments became available that far surpassed all prior interferon-based regimens in efficacy, tolerability, and safety. This led to rapid transformation of a hard-to-treat disease to simple, safe, and effective treatment offered to anyone. This article focuses on hepatitis C epidemiology; the clinical impact and consequences; discussion of past hepatitis C treatments; and a review of current recommendations for screening, diagnosis, and treatment of this ubiquitous virus.

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