Hepatitis C: existing and new treatments

The decision about when and how to manage hepatitis C virus (HCV) infection is based mainly on viral genotype, degree of liver fibrosis, and the relative benefits of using current treatments or waiting for new and more effective treatments to become available. Until 2011, management typically involved combinations of pegylated interferon and ribavirin. This resulted in a sustained viral response (ie, undetectable HCV RNA level 6 months after treatment) in less than half of patients with the most common genotype in the United States and resulted in frequent adverse events. In addition, there were no options for retreatment if initial treatment failed. Since 2011, new treatments in the form of direct-acting antivirals (DAAs) have become available. Although they are expensive, DAAs are much more effective than earlier treatments, with cure rates exceeding 90%. New treatment guidelines have been issued that include DAA regimens. These regimens are easier and shorter than older ones, and research has shown that treatment can be administered effectively by family physicians working in collaboration with hepatology subspecialists. Treatment for HCV infection should be accompanied by counseling for patients to avoid hepatotoxic substances, pregnancy during and for 6 months after treatment, and behaviors that might lead to reinfection.