Treating hepatitis C: the state of the art

Treatment of chronic hepatitis C has improved significantly, but more effective and well-tolerated therapies are needed. While new therapies are being developed, it is important to optimize the use of currently available treatments. Current treatment regimens are associated with substantial side effects, especially hematologic and neuropsychiatric side effects, that can lead to nonadherence, dose reduction, and treatment discontinuation. Because treatment adherence is critical to achieving a sustained virologic response, especially in patients who have genotype 1, early recognition and appropriate management of these side effects should lead to improved patient outcomes. Pending the availability of new therapies, further progress can be made mainly by maximizing benefits for individuals infected with HCV through appropriate selection of patients for antiviral treatment and increasing treatment adherence through better patient and caregiver education, closer patient follow-up, and more aggressive management of the side effects that lead to dose reduction or discontinuation. Further clinical and research efforts are needed to expand treatment to subgroups of patients previously considered ineligible because of comorbidities such as psychiatric and substance-use disorders. Optimum management of patients with hepatitis C will involve a larger cooperative team effort that includes physician specialists from various disciplines, including mental health care providers and physician extenders. Continued efforts are needed to develop novel therapies and treatment approaches to benefit patients who do not respond to current therapies, to increase our understanding of the natural history and pathology of HCV infection, and to promote public education to better identify infected individuals and improve hepatitis C prevention.