[Hepatitis C treatment in special patient groups]

Area of Science:

• Hepatology and Viral Gastroenterology
• Infectious Diseases and Public Health

Context:

• Chronic hepatitis C treatment presents unique challenges in special populations with comorbidities.
• Traditional therapies like dual therapy (pegylated interferon plus ribavirin) show limited efficacy in certain groups, such as those with HIV coinfection.

Purpose:

• To outline current evidence-based treatment strategies for chronic hepatitis C in diverse patient populations.
• To highlight the role of novel direct-acting antiviral agents and their implications for treatment decisions.

Summary:

• Dual therapy is insufficient for hepatitis C virus (HCV) and HIV coinfection. Triple therapy with protease inhibitors improved response rates in genotype 1 but has drug interaction and adverse effect concerns.
• Second-generation direct-acting antiviral agents are preferred for liver transplant candidates/recipients, often combined with ribavirin. Patients on hemodialysis still primarily use dual therapy due to limited data on newer agents.
• For mixed cryoglobulinemia, triple therapy appears superior to dual therapy, potentially serving as rescue treatment.

Impact:

• Advances in direct-acting antiviral agents are revolutionizing hepatitis C treatment, offering better outcomes and safety profiles in complex patient groups.
• Personalized treatment strategies are crucial for optimizing hepatitis C management in special populations, considering comorbidities and drug interactions.
• Further research is needed to establish optimal treatment regimens for patients undergoing hemodialysis and those with mixed cryoglobulinemia.